scholarly journals Non-steroidal anti-inflammatory drugs in the pharmacological management of osteoarthritis in the very old: prescribe or proscribe?

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110221
Author(s):  
Christian Cadet ◽  
Emmanuel Maheu ◽  
Keyword(s):  
Elderly Patients ◽  
Excess Mortality ◽  
Absolute Risk ◽  
Accurate Information ◽  
Plain Language ◽  
Very Elderly ◽  
Old Patients ◽  
Very Old ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Osteoarthritis (OA) is the most common form of arthritis worldwide, and ranges in the top 5–10 most disabling diseases. Contrary to common opinion, this disease is severe, often symptomatic, and may lead to loss of mobility and independence, as well as being responsible for increased frailty and excess mortality [standardized ratio: 1.55 (95% confidence interval, CI: 1.41–1.70)]. The incidence of OA increases dramatically with age in an increasingly ageing world. Therefore, practitioners involved in the management of OA often have to manage very old patients, aged 75–80 years and above, as part of their daily practice. Treatment options are limited. In addition to education and physical treatments, which are at the forefront of all treatment recommendations but require a low level of symptoms to be implemented, many pharmacological options are proposed. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as a second-line treatment but with great caution. However, the precise incidence of cardiovascular, renal, and gastrointestinal adverse events in very elderly patients is unclear. All of these risks are increased in the elderly. The relative risks can be extrapolated from various studies. However, what is the absolute risk according to age categorization? The answer to this question is important because NSAIDs should be used in very elderly patients with OA only if full information has been provided and the decision to prescribe this treatment is shared between the patient and their doctor. This article reviews the risks and currently available recommendations, and proposes practical options and warnings to allow for a responsible and limited use of NSAIDs in the very old. Plain language summary NSAIDS in the very Old : Prescribe or Proscribe? Osteoarthritis (OA) in the very old is a serious disease leading to loss of independence, frailty, and excess mortality. Quantitative data from clinical trials and population-based observational studies on the risk of NSAID-related side effects allow the prescriber to provide more accurate information to each patient. If there is no contraindication, the decision to initiate NSAID therapy in a very old OA patient should be made in a shared manner, with the patient fully informed of the risks.

Abstract P282: First-ever Ischemic Stroke in the Very Elderly: Trends, Characteristics and Outcome in a National Registry

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Alex Y Gur ◽  
David Tanne ◽  
Natan M Bornstein ◽  
Ron Milo ◽  
Eitan Auriel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Functional Disability ◽  
National Registry ◽  
Elderly Subjects ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Very Elderly ◽  
Old Patients ◽  
Very Old

Background: The incidence of ischemic stroke significantly increases with age. With increasing life expectancy, very old subjects will constitute the majority of stroke patients. However, epidemiological and clinical features of very elderly patients with stroke are still uncertain. Our aim was to study the patients' characteristics, outcome and trends in the very elderly (aged ≥ 85 years) in comparison with patients aged 65–84 years with a first-ever ischemic stroke in the National Acute Stroke Israeli Survey (NASIS) registry. Methods: The NASIS registry is a nationwide prospective hospital-based study performed triennially (2004, 2007, 2010). Patients with ischemic stroke aged ≥85 years were compared with those 65–84 years old regarding their baseline characteristics, stroke severity, etiology of stroke and stroke outcomes. Stroke severity was determined according to the National Institute of Health stroke scale (NIHSS) score and functional disability using the modified Rankin scale (mRS). Logistic regression analyses were used in the comparison of outcomes adjusting for potential confounders. Trends in patients' characteristics and stroke outcome were studied. Results: A first-ever ischemic stroke was diagnosed in 3125 patients. The proportion of very elderly (≥85 years) patients among the NASIS population increased from 18.3% in 2004 to 19.9% in 2007 and 24.5% in 2010 (p=0.005). The percentage of women was higher in patients aged ≥85 years (p<0.0001). Atrial fibrillation, congestive heart disease and prior disability were significantly more prevalent in the very elderly. The very elderly presented with more severe strokes: 36.3% of the ≥85 years-old patients had NIHSS≥11 compared with 22.0% in the younger age group. Adjusted rates of in-hospital complications [OR (95% CI=1.7 (1.3–2.2)] and severe disability or death (mRS>3) [1.4 (1.0–1.9)] were increased for very elderly patients. In the analysis of trends by registry period, rates of dyslipidemia increased from 25.4% in 2004 to 63.7% in 2010 (p for trend<0.0001) and hypertension increased from 74.8% in 2004 to 90.5% in 2010 (p for trend=0.0004). A significant decrease in the rate of in-hospital mortality among the very old patients is evident: rates decreased from 18.7% in 2004 to 5.7% in 2010 (p for trend=0.0005). Conclusions: There is an increasing proportion of very elderly subjects, mostly women, among first-ever ischemic stroke patients. Current information on age specific aspects of stroke in the very elderly is crucial to set up successful prevention pathways and implementing well-organized stroke care for this population.

DO NSAIDS CAUSE SPECIFIC COMPLICATIONS IN COVID-19 CORONAVIRUS INFECTION?

2020 ◽  
Vol 58 (3) ◽  
pp. 340-343 ◽  
Author(s):  
A. E. Karateev ◽  
E. L. Nasonov ◽  
A. M. Lila
Keyword(s):  
Gastrointestinal Tract ◽  
Elderly Patients ◽  
Cardiovascular System ◽  
Clinical Evidence ◽  
Correct Diagnosis ◽  
Viral Diseases ◽  
Inflammatory Drugs ◽  
Coronavirus Infection ◽  
Anti Inflammatory ◽  
Comorbid Diseases

Currently, there is no clear data indicating the risk of specific complications when using non-steroidal anti-inflammatory drugs (NSAIDs), and in particular ibuprofen, for COVID-19 infection. There is also no clear clinical evidence that taking NSAIDs increases the risk of COVID-19 infection. However, when using NSAIDs in patients with acute respiratory viral diseases, keep in mind the possibility of class-specific complications from the gastrointestinal tract, cardiovascular system and kidneys. This risk is quite serious in elderly patients with multiple comorbid diseases. In addition, you should remember that taking NSAIDs and paracetamol can mask important symptoms of COVID-19 infection (in particular, fever) and lengthen the time for making a correct diagnosis.

scholarly journals Risk of gastrointestinal bleeding associated with oral anticoagulation and non-steroidal anti-inflammatory drugs in patients with atrial fibrillation: a nationwide study

2019 ◽  
Vol 6 (5) ◽  
pp. 292-300 ◽  
Author(s):  
Anne-Marie Schjerning Olsen ◽  
Patricia McGettigan ◽  
Thomas Alexander Gerds ◽  
Emil Loldrup Fosbøl ◽  
Jonas Bjerring Olesen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gastrointestinal Bleeding ◽  
Vitamin K ◽  
Absolute Risk ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Nsaid Therapy ◽  
Short Term ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Aims Non-vitamin K antagonist oral anticoagulants (NOACs) are displacing vitamin K antagonists (VKAs) for stroke prophylaxis in patients with atrial fibrillation (AF). Concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) could increase gastrointestinal bleeding (GIB) risks among these patients. The aim of this study was to examine the risk of GIB among Danish AF patients taking oral anticoagulants (OACs) and NSAIDs. Methods and results Using nationwide administrative registries, we determined concomitant NSAID use among anticoagulant-naïve patients with AF initiating OACs between August 2011 and June 2017. We calculated short-term absolute risks differences and hazard ratios (HRs) for GIB based on multiple adjusted cause-specific Cox regressions with time-dependent NSAID treatment. Among 41 183 patients [median age 70 years (interquartile range 64–78); 55% men], 21% of patients on NOACs and 18% on VKA were co-prescribed NSAIDs. The differences in absolute risk [95% confidence interval (CI)] of GIB within 14 days of commencing concomitant NSAID therapy (vs. no concomitant NSAID therapy) were 0.10% (0.04–0.18%) for NOACs and 0.13% (0.03–0.24%) for VKA. NOACs overall were associated with less GIB than VKA [HR 0.77 (95% CI 0.69–0.85)]. Compared with OACs alone, concomitant NSAIDs doubled the GIB risk associated with NOACs overall [HR 2.01 (95% CI 1.40–2.61)] and with VKA [HR 1.95 (95% CI 1.21–2.69)]. Conclusion Among this nationwide AF population taking OACs, concomitant NSAID therapy increased the short-term absolute risk of GIB. Non-vitamin K antagonist oral anticoagulants alone were associated with lower GIB risks than VKA but concomitant NSAIDs abolished this advantage. The findings align with post hoc analyses from randomized studies. Physicians should exercise appropriate caution when prescribing NSAIDs for patients with AF taking NOACs or VKA.

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