Safety of nonsteroidal antiinflammatory drugs in patients with cardiovascular disease

Pharmacotherapy. 2015 May;35(5):520-35. doi: 10.1002/phar.1584. Epub 2015 May 4.


Nonsteroidal antiinflammatory drugs (NSAIDs) are used in the management of a variety of conditions, but their prevalence is likely underreported as a result of widespread availability and the perception that nonprescription therapies are unnecessary to report during medication history taking. However, NSAIDs are associated with a number of adverse effects, especially in patients with cardiovascular disease (CVD). Patients with CVD and comorbidities for which NSAIDs may provide symptomatic relief (e.g., osteoarthritis, rheumatoid arthritis) tend to be older, which places them at greater risk of harm. For these reasons, the use of NSAIDs in patients with CVD is a significant public health concern. An understanding of the risks associated with NSAIDs is critical for clinicians across practice settings. In this review, we detail the safety of NSAIDs in patients with CVD, provide recommendations on their use in specific disease states, and discuss therapeutic alternatives.

Keywords: bleeding; cardiac surgery; cardiovascular disease; noncardiac surgery; nonsteroidal antiinflammatory drugs.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology
  • Anticoagulants / adverse effects
  • Aspirin / adverse effects
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / physiopathology
  • Blood Pressure / drug effects
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / physiopathology
  • Cyclooxygenase Inhibitors / adverse effects
  • Drug Interactions
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Hemorrhage / chemically induced
  • Humans
  • Platelet Aggregation Inhibitors / adverse effects
  • Risk
  • Stroke / etiology
  • Stroke / physiopathology
  • Surgical Procedures, Operative


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Cyclooxygenase Inhibitors
  • Platelet Aggregation Inhibitors
  • Aspirin