Balancing Pain Relief and Safety: Gastrointestinal and Cardiovascular Risk Assessment in Nonsteroidal Anti-Inflammatory Drug Users and the Role of Gastroprotective Co-Therapy

TL;DR

This study examines how NSAIDs are prescribed and whether patients at risk for GI or CV issues receive proper gastroprotective therapy.

Contribution

The study highlights suboptimal adherence to gastroprotective guidelines and identifies factors influencing NSAID selection in high-risk patients.

Findings

Only 42.1% of patients received proton-pump inhibitors despite guidelines.

Non-selective NSAIDs were significantly linked to CV history and GI risk.

Age, gender, CV history, and GI risk significantly influenced NSAID selection.

Abstract

Background/Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management but pose gastrointestinal (GI) and cardiovascular (CV) risks, particularly during long-term use. This study evaluated NSAID-prescribing patterns and the appropriateness of gastroprotective co-therapy among patients with varying GI and CV risk profiles. Methods: An observational, cross-sectional study was conducted in the outpatient pharmacy department over six months (March 2023 to August 2023) at a public secondary care facility. Data pertaining to patient demographics, NSAIDs prescription, and GI/CV risks were collected and reviewed from electronic health records. Descriptive statistics, chi-square tests, and logistic regression were performed. Results: A total of 1005 prescriptions containing 2051 NSAIDs were analyzed. Selective COX-2 inhibitors and non-selective NSAIDs were the most frequently prescribed. Only 42.1% of patients received proton-pump inhibitors despite guideline recommendations. Non-selective NSAIDs were significantly associated with CV history and GI risk (p < 0.0001). Logistic regression showed age, gender, CV history, and GI risk significantly influenced NSAID selection. Notably, non-selective NSAIDs continued to be prescribed among moderate- and high-GI-risk patients. Conclusions: Suboptimal adherence to guideline-recommended gastroprotective strategies was evident, particularly among high-risk patients. Comprehensive GI and CV risk assessment and the rational use of gastroprotective co-therapy are essential. Integrating evidence-based digital tools may enhance safer NSAID prescribing in routine practice.

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