Non‐steroidal anti‐inflammatory drug administration after coronary artery bypass surgery: utilization persists despite the boxed warning. (22nd April 2015)

• Record Type: Journal Article
• Authors: Kulik, Alexander; Bykov, Katsiaryna; Choudhry, Niteesh K.; Bateman, Brian T.
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 24:Number 6(2015:Jun.)
• Page Start: 647
• Page End: 653
• Publication Date: 2015-04-22
• Subjects: Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.3788
• Languages: English
• ISSNs: 1053-8569

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pds3788-sec-0001" sec-type="section"> <title>Purpose</title> <p>In 2005, the US Food and Drug Administration (FDA) issued a boxed warning against the administration of non‐steroidal anti‐inflammatory drugs (NSAIDs) after coronary artery bypass graft (CABG) surgery because of cardiovascular safety concerns. We assessed utilization rates before and after the advisory and evaluated predictors of NSAID administration following CABG.</p> </sec> <sec id="pds3788-sec-0002" sec-type="section"> <title>Methods</title> <p>We assembled a cohort of 277 576 patients who underwent CABG from 2004 to 2010. Temporal trends in NSAID exposure were evaluated, and predictors of postoperative NSAID use were identified using generalized estimating equations.</p> </sec> <sec id="pds3788-sec-0003" sec-type="section"> <title>Results</title> <p>Over the study period, 92 938 CABG patients (33.5%) received NSAIDs following surgery. The frequency of NSAID administration declined steadily over time, from a peak of 38.9% in 2004 to a low of 29.0% in 2010 (<italic>p</italic> < 0.0007). Ketorolac was the most frequent NSAID prescribed, commonly on the first postoperative day. Surgery performed after the boxed warning was independently associated with a 20% lower odds of NSAID administration [odds ratio (OR): 0.80; <italic>p</italic> = 0.0003]. Other factors that predicted a lower odds of NSAID use following surgery included a history of renal disease (OR: 0.33; <italic>p</italic> < 0.0001) and liver disease (OR: 0.66; <italic>p</italic> < 0.0001), and the need for concurrent valve surgery (OR: 0.78; <italic>p</italic> < 0.0001). A mammary graft at the time of surgery increased the odds of NSAID administration (OR: 1.23; <italic>p</italic> < 0.0001).</p> </sec> <sec id="pds3788-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The frequency of NSAID administration after CABG has declined since the FDA advisory, yet many patients continue to receive them in recent years. Our data highlight the need for future research initiatives to further define the risks associated with NSAID use in this population. Copyright © 2015 John Wiley & Sons, Ltd.</p> </sec> </abstract>