Risk of stroke associated with non-steroidal anti-inflammatory drugs: a nested case-control study

S. Bak, M. Andersen, I. Tsiropoulos, L.A. García Rodríguez, Jesper Hallas, K. Christensen, D. Gaist

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background and Purpose— Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs.

Methods— We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.

Results— The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates.

Conclusions— Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.
Original languageEnglish
JournalStroke
Volume34
Issue number2
Pages (from-to)379-385
ISSN0039-2499
DOIs
Publication statusPublished - 2003

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Case-Control Studies
Pharmaceutical Preparations
Population
Registries
Odds Ratio
Cyclooxygenase 1
Drug Users
Prescriptions
Confidence Intervals

Cite this

@article{812c3440ba9a11dc9626000ea68e967b,
title = "Risk of stroke associated with non-steroidal anti-inflammatory drugs: a nested case-control study",
abstract = "Background and Purpose— Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs.Methods— We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.Results— The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95{\%} CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95{\%} CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95{\%} confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates.Conclusions— Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.",
author = "S. Bak and M. Andersen and I. Tsiropoulos and {Garc{\'i}a Rodr{\'i}guez}, L.A. and Jesper Hallas and K. Christensen and D. Gaist",
year = "2003",
doi = "10.1161/01.STR.0000053029.45352.A0",
language = "English",
volume = "34",
pages = "379--385",
journal = "Stroke",
issn = "0039-2499",
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Risk of stroke associated with non-steroidal anti-inflammatory drugs : a nested case-control study. / Bak, S.; Andersen, M.; Tsiropoulos, I.; García Rodríguez, L.A.; Hallas, Jesper; Christensen, K.; Gaist, D.

In: Stroke, Vol. 34, No. 2, 2003, p. 379-385.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Risk of stroke associated with non-steroidal anti-inflammatory drugs

T2 - a nested case-control study

AU - Bak, S.

AU - Andersen, M.

AU - Tsiropoulos, I.

AU - García Rodríguez, L.A.

AU - Hallas, Jesper

AU - Christensen, K.

AU - Gaist, D.

PY - 2003

Y1 - 2003

N2 - Background and Purpose— Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs.Methods— We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.Results— The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates.Conclusions— Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.

AB - Background and Purpose— Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs.Methods— We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.Results— The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates.Conclusions— Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.

U2 - 10.1161/01.STR.0000053029.45352.A0

DO - 10.1161/01.STR.0000053029.45352.A0

M3 - Journal article

VL - 34

SP - 379

EP - 385

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 2

ER -