Session Information
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose :
The association between NSAIDs use and myocardial infarction has been
demonstrated in many studies. However, the relation between NSAIDs use and venous
thromboembolism (VTE) remains controversial. We aimed to examine whether the
current users of specific NSAIDs have an increased risk of VTE among knee OA
patients.
Methods :
We conducted a population-based case-control study using The Health Improvement
Network (THIN), a database of patient records from general practices in the UK.
For every VTE case, we identified 5 controls matched on age, sex, and calendar
year of study enrolment. We used conditional logistic regression to assess the
association between current use of specific NSAIDs and risk of VTE relative to
remote NSAID users.
Results :
Among knee OA patients with at least one NSAID prescription, we identified 4020
incident cases of VTE and 20059 matched controls. Adjusted odd ratios (OR) relative
to the remote users were 1.38 (95% CI 1.32
– 1.44) for the recent users and 1.43 (95% CI 1.36 – 1.49) for current users. Among
the current NSAID users, the risk of VTE was increased with diclofenac (OR 1.63
[95% CI 1.53 – 1.74],
ibuprofen (OR 1.49 [1.38 – 1.62]),
meloxicam (OR 1.29 [1.11 – 1.50]) and coxibs (celecoxib OR 1.30 [95% CI 1.11 – 1.51]; rofecoxib OR 1.44
[95% CI 1.18 – 1.76]);
naproxen did not increase VTE risk (OR 1.00 [95% CI 0.89 – 1.12]).
Conclusion :
Compared with the remote users of NSAIDs, the risk of VTE increased for current
users of diclofenac, ibuprofen, and coxibs, but not for naproxen, in the knee
OA population.
Table 1.
Baseline Characteristics of the VTE Cases and matched controls
|
VTE Cases (n=4020) |
Controls (n=20059) |
|
|
Female – % |
2431 (60.5%) |
12137 (60.5%) |
|
Age (years) |
||
|
Mean ± S.D. |
72.7 ± 10.1 |
72.8 ± 10.0 |
|
< 60 |
479 (11.9%) |
2357 (11.8%) |
|
60 – 69 |
968 (24.1%) |
4840 (24.1%) |
|
≥ 70 |
2573 (64.0%) |
12862 (64.1%) |
|
BMI category (kg/m2) |
||
|
< 18.5 |
15 (0.4%) |
97 (0.5%) |
|
18.5 – 24.9 |
574 (15.9%) |
4079 (22.7%) |
|
25 – 29.9 |
1346 (37.2%) |
7420 (41.3%) |
|
≥ 30 |
1682 (46.5%) |
6373 (35.5%) |
|
Major risk factors for VTE |
|
|
|
Surgery |
338 (8.4%) |
1522 (7.6%) |
|
Any trauma |
274 (6.8%) |
1133 (5.6%) |
|
Cancer |
632 (15.7%) |
2276 (11.3%) |
|
Smoking |
|
|
|
None |
2319 (60.4%) |
11408 (59.4%) |
|
Past |
1114 (29.0%) |
5544 (28.8%) |
|
Current |
408 (10.6%) |
2267 (11.8%) |
|
Alcohol |
|
|
|
None |
877 (24.3%) |
4113 (22.8%) |
|
Past |
97 (2.7%) |
426 (2.4%) |
|
Current |
2634 (73.0%) |
13489 (74.8%) |
|
Other comorbidities |
||
|
Stroke |
375 (9.3%) |
1768 (8.8%) |
|
Ischemic heart disease |
788 (19.6%) |
3525 (17.6%) |
|
Chronic kidney disease |
468 (11.6%) |
2062 (10.3%) |
|
Liver disease |
98 (2.4%) |
476 (2.4%) |
|
Hypertension |
2012 (50.0%) |
9980 (49.8%) |
|
Diabetes |
484 (12.0%) |
2365 (11.8%) |
|
Hyperlipidemia |
1298 (32.3%) |
6654 (33.2%) |
|
Inflammatory conditions[a] |
594 (14.8%) |
2516 (12.5%) |
|
Rheumatoid arthritis |
110 (2.7%) |
477 (2.4%) |
|
NSAID use |
||
|
Remote user (any NSAID) |
2114 (52.6%) |
12208 (60.9%) |
|
Recent user (any NSAID) |
950 (23.6%) |
3991 (19.9%) |
|
Current diclofenac user |
396 (9.9%) |
1433 (7.1%) |
|
Current ibuprofen |
218 (5.4%) |
861 (4.3%) |
|
Current naproxen user |
96 (2.4%) |
550 (2.7%) |
|
Current meloxicam user |
57 (1.4%) |
250 (1.2%) |
|
Current celecoxib user |
59 (1.5%) |
248 (1.2%) |
|
Current rofecoxib user |
34 (0.8%) |
129 (0.6%) |
|
Current other coxib user |
25 (0.6%) |
100 (0.5%) |
|
Current other NSAIDs user |
71 (1.8%) |
289 (1.4%) |
|
Other medication use |
||
|
Glucocorticoids |
445 (11.1%) |
1459 (7.3%) |
|
Aspirin |
1147 (28.5%) |
5319 (26.5%) |
|
Hormone replacement therapy |
141 (3.5%) |
689 (3.4%) |
|
Medical service utilization |
||
|
Specialist referral |
1547 (38.5%) |
6670 (33.3%) |
|
GP visits |
5.6 ± 4.4 |
4.8 ± 3.9 |
|
Hospitalizations |
0.37 ± 1.0 |
0.28 ± 0.8 |
Table 2.
Risk of VTE with usage of specific NSAIDs compared with remote usage of any NSAID
|
|
Cases |
Controls |
Crude OR[b] (95% CI) |
Adjusted OR[c] (95% CI) |
|
Remote use (any NSAID) |
2114 |
12208 |
1 (reference) |
1 (reference) |
|
Recent use (any NSAID) |
950 |
3991 |
1.40 (1.34 – 1.47) |
1.38 (1.32 – 1.44) |
|
Current use |
956 |
3860 |
1.47 (1.40 – 1.53) |
1.43 (1.36 – 1.49) |
|
Diclofenac |
396 |
1433 |
1.66 (1.56 – 1.77) |
1.63 (1.53 – 1.74) |
|
Ibuprofen |
218 |
861 |
1.49 (1.37 – 1.61) |
1.49 (1.38 – 1.62) |
|
Naproxen |
96 |
550 |
1.02 (0.91 – 1.14) |
1.00 (0.89 – 1.12) |
|
Meloxicam |
57 |
250 |
1.34 (1.16 – 1.56) |
1.29 (1.11 – 1.50) |
|
Celecoxib |
59 |
248 |
1.43 (1.23 – 1.66) |
1.30 (1.11 – 1.51) |
|
Rofecoxib |
34 |
129 |
1.60 (1.32 – 1.95) |
1.44 (1.18 – 1.76) |
|
Other coxibs |
25 |
100 |
1.46 (1.17 – 1.83) |
1.45 (1.15 – 1.83) |
|
Other NSAIDs |
71 |
289 |
1.46 (1.27 – 1.67) |
1.34 (1.17 – 1.54) |
[a]Seronegative
Spondyloarthropathy/Psoriasis, Connective Tissue Disease, Vasculitidies, and
Crystal Arthropathies.
[b] Adjusted for
age, sex, and calendar year.
[c]
Adjusted for age, sex,
calendar year, surgery, trauma, cancer, BMI, smoking, ischemic heart disease,
hypertension, diabetes, hyperlipidemia, inflammatory conditions, glucocorticoid
use, number of GP visits, specialist referral, and hospitalizations.
To cite this abstract in AMA style:
Lee T, Lu N, Felson DT, Choi HK, Dalal DS, Zhang Y, Dubreuil M. Use of Nsaids Correlates with the Risk of Venous Thromboembolism in Knee OA Patients: A UK Population-Based Case-Control Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/use-of-nsaids-correlates-with-the-risk-of-venous-thromboembolism-in-knee-oa-patients-a-uk-population-based-case-control-study/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-nsaids-correlates-with-the-risk-of-venous-thromboembolism-in-knee-oa-patients-a-uk-population-based-case-control-study/