Initiating NSAIDs May Increase Women’s VTE Risk

Women who initiate nonsteroidal anti-inflammatory drugs (NSAIDs) may be at a greater risk for venous thromboembolism (VTE) compared with women who do not use NSAIDs, according to findings of a new study. However, this association was null or diminished when compared with women who initiated acetaminophen.

To evaluate VTE risk following new use of NSAIDs, the researchers analyzed data on 39,876 women enrolled in the Women’s Health Study from 1993 to 1995 and who were followed up with yearly questionnaires until 2012.

The study authors assessed the women’s initiation of COX-2 inhibitors (coxibs) and traditional NSAIDs (excluding aspirin) as well as their incident VTE. While initiation was defined as the first reported use of NSAIDs for 4 or more days per month, incident VTE was confirmed by an end-point committee.

In the as-treated analyses that compared initiation with non-initiation, the hazard ratio (HR) for VTE risk was 1.5 (95% CI, 1.2-1.8) for any NSAID, 1.3 (95% CI, 1.1-1.7) for traditional NSAIDs, and 2.0 (95% CI, 1.3-3.1) for coxibs. The 2-year risk differences between those who initiated treatment and those who did not were 0.11 for any NSAID, 0.08 for traditional NSAIDs, and 0.32 for coxibs.

“Elevated VTE risks associated with NSAID use in observational studies may in part reflect different baseline risks among individuals who need analgesics and may overstate the risk patients incur compared with pharmacologic alternatives,” the researchers concluded.

—Colleen Murphy

Reference:

Kinsey TL, Stürmer T, Funk MJ, Poole C, Simpson RJ Jr, Glynn RJ. Incidence of venous thromboembolism following initiation of non-steroidal anti-inflammatory drugs in U.S. women [published online January 28, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez653.