Risk of cardiovascular events in the use of nonsteroidal anti-inflammatory drugs during the perioperative period: a meta-analysis / 临床麻醉学杂志

ABSTRACT

Objective To evaluate the risk of cardiovascular adverse events using nonsteroidal anti-inflammatory drugs during the perioperative period.Methods A systematic review of formally published in English and Chinese literature was conducted by using computerized database on PubMed, Web of Science, Medline, Cochrane Library, CNKI and Wanfang database.The literature about controlled clinical study of nonsteroidal anti-inflammatory drugs in perioperative use, a prospective cohort study and a retrospective review were collected.The cardiovascular risk was evaluated by the number of adverse cardiovascular events cases (myocardial infarction, angina, myocardial ischemia, arrhythmia) occurred during the period of drug use.The relevant data was extracted and their heterogeneity was tested.Results A total of 8 articles including 15 623 patients met the inclusion criteria, including 5 articles (n=13 019) on non-selective nonsteroidal anti-inflammatory drugs, and 3 articles (n=2 604) about selective (cyclooxygenase 2) COX-2 inhibitors.Nonsteroidal anti-inflammatory drugs used in the perioperative or a short term would reduce the risk of adverse cardiovascular events (OR=0.59, 95%CI 0.45-0.77, P=0.000 1), non-selective nonsteroidal anti-inflammatory drugs using in the perioperative or a short term would reduce the risk of adverse cardiovascular events, the difference being statistically significant (OR=0.42, 95%CI 0.31-0.58, P＜0.001).A selective COX-2 inhibitor using in the perioperative or short-term might increase cardiovascular adverse events (OR=2.53, 95%CI 1.26-5.09, P=0.009).Conclusion Non-selective nonsteroidal anti-inflammatory drugs should be chosen for patients at high risk of adverse cardiovascular events during the perioperative period.