Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 30153662 · doi:10.1159/000490741
What was done
Authors searched PubMed, EMBASE, Scopus, and Web of Science (January 1, 1990 to July 30, 2017) for English-language epidemiological studies examining the link between NSAID use and hemorrhagic stroke. Quality was evaluated using Cochrane guidelines and Newcastle-Ottawa criteria. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model, alongside subgroup and sensitivity analyses.
What was found
Thirteen studies met inclusion criteria from 785 unique abstracts. Overall pooled risk of hemorrhagic stroke was significantly increased among NSAID users (RR 1.332, 95% CI 1.105–1.605, p = 0.003). Subgroup analyses found elevated risks for specific NSAIDs: meloxicam (RR 1.48, 95% CI 1.149–1.912), diclofenac (RR 1.392, 95% CI 1.107–1.751), and indomethacin (RR 1.363, 95% CI 1.088–1.706). Risk was elevated in Asian studies (RR 1.490, 95% CI 1.226–1.811) and European studies (RR 1.393, 95% CI 1.104–1.757), but did not reach statistical significance in Australian studies (RR 1.361, 95% CI 0.755–2.452).
Why it matters
This review identifies a moderate association between NSAID use and hemorrhagic stroke, highlighting specific risk elevations with meloxicam, diclofenac, and indomethacin that warrant clinical caution.
Limits
The underlying evidence is limited to observational studies, making findings vulnerable to unmeasured confounding and confounding by indication. The total number of participants, dosage data, treatment duration, and non-English publications were not reported in the abstract.
Cited by
- partial Chronic use of NSAIDs or H2-blocking acid reducers is associated with a dramatic increased risk of dementia and stroke.