Arthritis Pain Relievers May Raise Risk of Death From Stroke

COX 2 inhibitors linked to increased risk of death within one month of first stroke

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Arthritis can be painful and prevent patients from doing daily activities. But certain medicines to relieve arthritis pain may increase patients' chances of dying from a stroke, a new study found.

When people who have high blood pressure take COX-2 inhibitors for arthritis, they may be much more likely to die from stroke, according to the new Danish study.

The study authors said people with a raised risk of stroke should not take COX-2 inhibitors.

"Our study supports stepping up efforts to make sure people with a higher risk of stroke are not prescribed these medications when other options are available,” said study author Morten Schmidt, MD, of Aarhus University Hospital in Denmark, in a press release.

In the top five leading causes of death, stroke stands fourth in the United States, according to the Centers for Disease Control and Prevention. Even when a stroke doesn't cause death, it can result in loss of vision or speech, make it hard to walk or affect patients' ability to think.

Older adults are more likely to have high blood pressure, which can increase the risk of stroke. They are also more likely to have arthritis.

Doctors often prescribe pain medicines called NSAIDs for patients who have arthritis. Arthritis is an inflammation of the joints that can cause pain, swelling and stiffness. Among these medicines are COX-2 inhibitors, which target an enzyme called COX-2 to reduce pain and inflammation. Non COX-2 NSAIDs include over-the-counter medicines like ibuprofen (brand name Advil).

Dr. Schmidt and colleagues studied 100,243 people who had been hospitalized for a first stroke between 2004 and 2012. Within that group, they looked at people who had died within one month of having a stroke. Finally, they looked at whether the patients were current or former users of NSAIDs.

To be considered an NSAID user, the patient had to have taken the medicine within two months before the stroke. The researchers separated current users into long-term or new users.

Eleven percent of the patients used NSAIDs at the time of admission to the hospital. Eight percent were former users, and 81 percent did not use the medications.

Patients who used COX-2 inhibitors were 19 to 53 percent more likely to die from a stroke, the study authors found.

The COX-2 inhibitors included medications like diclofenac (brand names Voltaren, Flector and Zipsor) and etodolac (brand name Lodine), celecoxib (brand name Celebrex) and rofecoxib (brand name Vioxx). Other non COX-2 NSAIDs included naproxen (brand names Aleve, Naprosyn). Of the patients in the study who used NSAIDs, 27 percent used diclofenac.

The researchers found that 11 percent of the patients used etodolac, 3 percent used naproxen and 1 percent used celecoxib. Only 0.5 percent used rofecoxib (Vioxx). Vioxx was withdrawn from the market in 2004 due to a possible increased risk of heart disease and stroke.

Over 10 percent of people who were current users of COX-2 inhibitors died of stroke. Only 8.7 percent of those who did not take the medications died.

New users of older COX-2 medicines such as rofecoxib were 42 percent more likely to die of stroke than those who did not take the medications, the authors found. Patients who took etodolac were 53 percent more likely to die of a stroke when compared to those who did not take the medicine.

Other non COX-2 NSAIDs like ibuprofen and naproxen, however, did not appear to increase the risk of death from stroke.

This study was published Nov. 5 in Neurology.

The researchers did not disclose any funding sources or conflicts of interest.

Review Date: 
November 5, 2014
Last Updated:
November 11, 2014