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All pain medications may raise risk of heart attack or stroke

October 09, 2017

Now, research suggests that some commonly used pain medications??”not just the now-banned Vioxx??”can raise the risk of having a heart attack or stroke. New step-by-step recommendations from the American Heart Association (AHA) can help you choose a pain reliever that's good for both the heart and stomach, reports the June 2007 issue of the Harvard Heart Letter .

The AHA suggests starting with aspirin or acetaminophen (Tylenol) to quell muscle or joint pain. Aspirin is good for the heart, and acetaminophen doesn't affect blood clotting. If they don't work, the next step for most people would be a nonsteroidal anti-inflammatory drug (NSAID). Try naproxen (Aleve) first, then ibuprofen (Advil). Next is diclofenac, but more caution is needed with this drug (which is available only by prescription). Celebrex, the only drug in the class known as COX-2 inhibitors that remains on the market, should be the last resort for managing pain. In addition to the side effect of increasing the risk of clots in the bloodstream, COX-2 inhibitors can also reduce blood flow through the kidneys and raise blood pressure. For short-term pain in some people, a narcotic pain reliever such as tramadol (Ultram), codeine, or fentanyl (Actiq, Duragesic) may be an option.

The Harvard Heart Letter notes that you shouldn't be afraid to take aspirin, Tylenol, Advil, or Aleve for occasional aches and pains. But if you need a pain reliever several times a week, pay closer attention to your choices and talk with your doctor.

health.harvard/

Another reason was that the Hartford Hospital doctors avoided a specific lab/drug test interaction that can lead to inadequate anti-clotting treatment. "During bypass or heart valve surgery, patients receive a drug called heparin to prevent blood clot formation," Dr. White explained. "Surgery teams know how much to give because they measure the activated clotting time (ACT). Previous studies have found that aprotinin makes the ACT rise erroneously if celite-ACTs are used. If you are using celite-ACTs to guide heparin dosing in a patient treated with aprotinin, you will think you gave enough heparin when in fact you didn't." This interaction may explain some of the increased risks with aprotinin reported in previous studies.

However, Dr White did not want to dismiss the importance of the previous studies showing harm. "Those studies were important, because they clearly showed that the way aprotinin was used around the world, by and large, was hurting patients more than helping them," said Dr. White. "By using aprotinin selectively and avoiding the celite-ACT test, surgical teams can reduce the risk of bleeding problems during surgery without increasing the risks of heart attack or stroke."

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