Practice Guideline Briefs


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Am Fam Physician. 2007 Sep 15;76(6):894.

AHA Releases Statement on the Use of COX-2 Inhibitors and NSAIDs

Guideline source: American Heart Association

Literature search described? Yes

Evidence rating system used? No

Published source: Circulation, March 27, 2007

Available at:

Physicians should consider the increased risks associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), including cerebrovascular and cardiovascular events, according to new guidelines issued by the American Heart Association (AHA). Warning labels have been ordered and advisories on the increased risks of these events in patients who take NSAIDs have been issued to patients and physicians by several regulatory agencies.

Evidence further suggests that myocardial infarction, heart failure, hypertension, and stroke can occur at increased rates in patients who take cyclooxygenase-2 (COX-2) inhibitors. Persons with a history of cardiovascular disease and those at increased risk are more likely to experience these adverse effects.

For patients at increased risk of cardiovascular and cerebrovascular events, COX-2 inhibitors should be prescribed only if no alternative pain relief medications exist. If prescribed to patients at increased risk, COX-2 inhibitors should be given only at the lowest dosage and for the shortest duration necessary. The use of any COX inhibitor, including NSAIDs, for long periods should be considered only in consultation with a physician.


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