Cardiovascular and gastrointestinal safety of NSAIDs

OBJECTIVE To provide an overview of the recent literature on cardiovascular and gastrointestinal toxicity of NSAIDs. DESIGN: Narrative literature review. METHODS: For this narrative literature review relevant literature on cardiovascular toxicity was searched for using PubMed. Only meta-analyses were selected. The relevant literature on gastrointestinal toxicity was also searched for in PubMed, focussing on three main questions to be answered: are coxibs equal to non-selective NSAIDs combined with a proton pump inhibitor (PPI); what to do in patients with a previous gastrointestinal complication; and does the combination of a coxib with a PPI have additional value above the strategies mentioned in the first question? RESULTS AND CONCLUSION: All NSAIDs are cardiotoxic, with naproxen being the relatively safest one. Coxibs prevent gastrointestinal toxicity at least as good as non-selective NSAIDs plus a PPI, but the latter strategy is better in prevention of dyspepsia. After a serious gastrointestinal complication, all NSAIDs should be avoided. If an NSAID is necessary in such patients, a coxib plus a PPI is the safest option.