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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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