Risk of stroke associated with non-steroidal anti-inflammatory drugs: A nested case-control study.
Stroke 2003;34:379-386.
ABSTRACT
Methods: We used a population-based patient registry to identify all patients with a first ever stroke discharge diagnosis in the period 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40.000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from two large population-based surveys with more detailed information on risk factors.
Results: The cases were classified as intracerebral haemorrhage (N=659), subarachnoid haemorrhage (N=208) and ischaemic stroke (N=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9-1.6) for intracerebral haemorrhage, 1.2 (95% CI, 0.7-2.1) for subarachnoid haemorrhage and 1.2 (95% CI, 1.0-1.4) for ischaemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates.
Conclusions: Current exposure to NSAIDs is not a risk factor for intracerebral haemorrhage or subarachnoid haemorrhage. Furthermore, NSAIDs probably offer no protection against first ever ischaemic stroke.
Background and purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of haemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral haemorrhage, subarachnoid haemorrhage and ischaemic stroke in users of NSAIDs.