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November 25, 2014; 83 (22) Article

Preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality

Morten Schmidt, Erzsébet Hováth-Puhó, Christian Fynbo Christiansen, Karin L. Petersen, Hans Erik Bøtker, Henrik Toft Sørensen
First published November 5, 2014, DOI: https://doi.org/10.1212/WNL.0000000000001024
Morten Schmidt
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
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Erzsébet Hováth-Puhó
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
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Christian Fynbo Christiansen
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
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Karin L. Petersen
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
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Hans Erik Bøtker
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
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Henrik Toft Sørensen
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
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Citation
Preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality
Morten Schmidt, Erzsébet Hováth-Puhó, Christian Fynbo Christiansen, Karin L. Petersen, Hans Erik Bøtker, Henrik Toft Sørensen
Neurology Nov 2014, 83 (22) 2013-2022; DOI: 10.1212/WNL.0000000000001024

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Abstract

Objectives: To examine whether preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) influenced 30-day stroke mortality.

Methods: We conducted a nationwide population-based cohort study. Using medical databases, we identified all first-time stroke hospitalizations in Denmark between 2004 and 2012 (n = 100,043) and subsequent mortality. We categorized NSAID use as current (prescription redemption within 60 days before hospital admission), former, and nonuse. Current use was further classified as new or long-term use. Cox regression was used to compute hazard ratios (HRs) of death within 30 days, controlling for potential confounding through multivariable adjustment and propensity score matching.

Results: The adjusted HR of death for ischemic stroke was 1.19 (95% confidence interval [CI]: 1.02–1.38) for current users of selective cyclooxygenase (COX)-2 inhibitors compared with nonusers, driven by the effect among new users (1.42, 95% CI: 1.14–1.77). Comparing the different COX-2 inhibitors, the HR was driven by new use of older traditional COX-2 inhibitors (1.42, 95% CI: 1.14–1.78) among which it was 1.53 (95% CI: 1.02–2.28) for etodolac and 1.28 (95% CI: 0.98–1.68) for diclofenac. The propensity score–matched analysis supported the association between older COX-2 inhibitors and ischemic stroke mortality. There was no association for former users. Mortality from intracerebral hemorrhage was not associated with use of nonselective NSAIDs or COX-2 inhibitors.

Conclusions: Preadmission use of COX-2 inhibitors was associated with increased 30-day mortality after ischemic stroke, but not hemorrhagic stroke. Use of nonselective NSAIDs at time of admission was not associated with mortality from ischemic stroke or intracerebral hemorrhage.

GLOSSARY

CI=
confidence interval;
COPD=
chronic obstructive pulmonary disease;
COX=
cyclooxygenase;
DNRP=
Danish National Registry of Patients;
HR=
hazard ratio;
ICD=
International Classification of Diseases;
ICH=
intracerebral hemorrhage;
NSAID=
nonsteroidal anti-inflammatory drug;
PGE2=
prostaglandin E2;
SAH=
subarachnoid hemorrhage

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received February 23, 2014.
  • Accepted in final form September 2, 2014.
  • © 2014 American Academy of Neurology
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