OBJECTIVES: Treatment of acute pain often includes use of nonsteroidal anti-inflammatory drugs (NSAIDs). Although effective, they are known to cause adverse events (AEs), including gastrointestinal, cardiovascular, and renal events. The objective of this review was to assess the temporal relationship between NSAID use and risk of gastrointestinal, cardiovascular, and renal AEs
METHODS: For the systematic review, the PubMed electronic database was searched for articles published in English related to the temporal relationship between NSAIDs and development of gastrointestinal, cardiovascular, and/or renal AEs. A total of 719 abstracts were reviewed and 385 were identified as relevant studies for full screening; 16 studies were included.
RESULTS: Risk of gastrointestinal events was greatest in current users of NSAIDs and generally occurred within the first 30 days of treatment. Risk remained constant over the first year and quickly returned to baseline after NSAIDs were discontinued, generally within 2 months. Risk of a cardiovascular event, including first myocardial infarction, was more evident early in treatment (as early as 7 days; median, 9 days) and remained elevated for up to 1 week after the last prescription. In patients with a prior history of myocardial infarction, even short-term use was associated with increased risk. Acute renal failure was the most common form of NSAID-induced renal impairment, with rapid onset following administration of first dose, but was often reversible upon discontinuation of NSAIDs
CONCLUSIONS: The risk of gastrointestinal, cardiovascular, and renal NSAID-induced events can occur within the first 7 days after initiation of therapy. These events generally occur earlier than previously recognized, with the highest risk of an event occurring within the first few weeks. This trend either remains constant or decreases over time with long-term NSAID use.
