Morten Schmidt1, Erzsébet Hováth-Puhó2, Christian Fynbo Christiansen2, Karin L Petersen2, Hans Erik Bøtker2, Henrik Toft Sørensen2. 1. From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco. morten.schmidt@clin.au.dk. 2. From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
Abstract
OBJECTIVES: To examine whether preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) influenced 30-day stroke mortality. METHODS: We conducted a nationwide population-based cohort study. Using medical databases, we identified all first-time stroke hospitalizations in Denmark between 2004 and 2012 (n = 100,043) and subsequent mortality. We categorized NSAID use as current (prescription redemption within 60 days before hospital admission), former, and nonuse. Current use was further classified as new or long-term use. Cox regression was used to compute hazard ratios (HRs) of death within 30 days, controlling for potential confounding through multivariable adjustment and propensity score matching. RESULTS: The adjusted HR of death for ischemic stroke was 1.19 (95% confidence interval [CI]: 1.02-1.38) for current users of selective cyclooxygenase (COX)-2 inhibitors compared with nonusers, driven by the effect among new users (1.42, 95% CI: 1.14-1.77). Comparing the different COX-2 inhibitors, the HR was driven by new use of older traditional COX-2 inhibitors (1.42, 95% CI: 1.14-1.78) among which it was 1.53 (95% CI: 1.02-2.28) for etodolac and 1.28 (95% CI: 0.98-1.68) for diclofenac. The propensity score-matched analysis supported the association between older COX-2 inhibitors and ischemic stroke mortality. There was no association for former users. Mortality from intracerebral hemorrhage was not associated with use of nonselective NSAIDs or COX-2 inhibitors. CONCLUSIONS: Preadmission use of COX-2 inhibitors was associated with increased 30-day mortality after ischemic stroke, but not hemorrhagic stroke. Use of nonselective NSAIDs at time of admission was not associated with mortality from ischemic stroke or intracerebral hemorrhage.
OBJECTIVES: To examine whether preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) influenced 30-day stroke mortality. METHODS: We conducted a nationwide population-based cohort study. Using medical databases, we identified all first-time stroke hospitalizations in Denmark between 2004 and 2012 (n = 100,043) and subsequent mortality. We categorized NSAID use as current (prescription redemption within 60 days before hospital admission), former, and nonuse. Current use was further classified as new or long-term use. Cox regression was used to compute hazard ratios (HRs) of death within 30 days, controlling for potential confounding through multivariable adjustment and propensity score matching. RESULTS: The adjusted HR of death for ischemic stroke was 1.19 (95% confidence interval [CI]: 1.02-1.38) for current users of selective cyclooxygenase (COX)-2 inhibitors compared with nonusers, driven by the effect among new users (1.42, 95% CI: 1.14-1.77). Comparing the different COX-2 inhibitors, the HR was driven by new use of older traditional COX-2 inhibitors (1.42, 95% CI: 1.14-1.78) among which it was 1.53 (95% CI: 1.02-2.28) for etodolac and 1.28 (95% CI: 0.98-1.68) for diclofenac. The propensity score-matched analysis supported the association between older COX-2 inhibitors and ischemic stroke mortality. There was no association for former users. Mortality from intracerebral hemorrhage was not associated with use of nonselective NSAIDs or COX-2 inhibitors. CONCLUSIONS: Preadmission use of COX-2 inhibitors was associated with increased 30-day mortality after ischemic stroke, but not hemorrhagic stroke. Use of nonselective NSAIDs at time of admission was not associated with mortality from ischemic stroke or intracerebral hemorrhage.
Authors: Morten Schmidt; Sigrun Alba Johannesdottir Schmidt; Jakob Lynge Sandegaard; Vera Ehrenstein; Lars Pedersen; Henrik Toft Sørensen Journal: Clin Epidemiol Date: 2015-11-17 Impact factor: 4.790
Authors: Jaimie L Gradus; Dóra Körmendiné Farkas; Elisabeth Svensson; Vera Ehrenstein; Timothy L Lash; Arnold Milstein; Nancy Adler; Henrik Toft Sørensen Journal: BMJ Open Date: 2015-12-14 Impact factor: 2.692