Safety of Aspirin Plus NSAIDs in Patients at Increased Cardiovascular Risk

The double-blind PRECISION evaluated the cardiovascular safety of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with osteoarthritis or rheumatoid arthritis who either had established cardiovascular disease (CVD) or were considered at high risk for CVD (NEJM JW Cardiol Nov 2016). A secondary analysis was conducted evaluating the safety of NSAIDs combined with low-dose aspirin. Of the roughly 24,000 patients in PRECISION, about 11,000 used aspirin at the time of randomization to celecoxib, naproxen, or ibuprofen. Aspirin users were older, more likely to be male, and had a history of coronary artery disease, diabetes, hypertension, and hyperlipidemia.

In an analysis pooling all NSAIDs, the addition of aspirin yielded no significant …