FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2575271605> ?p ?o ?g. }

• W2575271605 endingPage "409" @default.
• W2575271605 startingPage "400" @default.
• W2575271605 abstract "IntroductionLimited studies have evaluated risk of stroke associated with the use of NSAIDs in patients with end-stage kidney disease. We examined the adverse effects of selective and nonselective NSAID use on the risk of stroke in dialysis patients.MethodsA case-crossover study was conducted using medical claims data from the National Health Insurance Research Database in Taiwan. We identified patients with ischemic and hemorrhagic stroke (defined as International Classification of Diseases, 9th revision, Clinical Modification codes 433, 434, and 436 for ischemic stroke and 430 and 431 for hemorrhagic stroke) from inpatient claims during the period from 2003 to 2012. Conditional logistic regression models with adjustment for potential confounders were used to determine the effects of NSAID use on stroke.ResultsA total of 1190 dialysis patients with stroke were identified from 2003 to 2012. The results indicate a 1.31-fold increased risk of stroke related to NSAID use during the 30 days prior to a stroke (AOR = 1.31; 95% CI: 1.03–1.66); likewise, an excessive risk of ischemic stroke was observed (AOR = 1.34; 95% CI: 1.02–1.77). When classifying NSAIDs into selective and nonselective groups, nonselective NSAID use was significantly associated with an increased risk of stroke (AOR = 1.27; 95% CI: 1.00–1.61).DiscussionIn summary, the results show supportive evidence that NSAID use increased the risk of stroke in dialysis patients, which suggests the importance of closely monitoring the transient effects of initial NSAID treatment to patients on dialysis. Limited studies have evaluated risk of stroke associated with the use of NSAIDs in patients with end-stage kidney disease. We examined the adverse effects of selective and nonselective NSAID use on the risk of stroke in dialysis patients. A case-crossover study was conducted using medical claims data from the National Health Insurance Research Database in Taiwan. We identified patients with ischemic and hemorrhagic stroke (defined as International Classification of Diseases, 9th revision, Clinical Modification codes 433, 434, and 436 for ischemic stroke and 430 and 431 for hemorrhagic stroke) from inpatient claims during the period from 2003 to 2012. Conditional logistic regression models with adjustment for potential confounders were used to determine the effects of NSAID use on stroke. A total of 1190 dialysis patients with stroke were identified from 2003 to 2012. The results indicate a 1.31-fold increased risk of stroke related to NSAID use during the 30 days prior to a stroke (AOR = 1.31; 95% CI: 1.03–1.66); likewise, an excessive risk of ischemic stroke was observed (AOR = 1.34; 95% CI: 1.02–1.77). When classifying NSAIDs into selective and nonselective groups, nonselective NSAID use was significantly associated with an increased risk of stroke (AOR = 1.27; 95% CI: 1.00–1.61). In summary, the results show supportive evidence that NSAID use increased the risk of stroke in dialysis patients, which suggests the importance of closely monitoring the transient effects of initial NSAID treatment to patients on dialysis. During the past few decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been extensively used worldwide for managing fever, inflammation, and pain.1Patrono C. Baigent C. Nonsteroidal anti-inflammatory drugs and the heart.Circulation. 2014; 129: 907-916Crossref PubMed Scopus (87) Google Scholar However, previous studies have indicated that use of individual NSAIDs was associated with an elevated risk of cerebrovascular events.2Solomon S.D. McMurray J.J. Pfeffer M.A. et al.for the Adenoma Prevention with Celecoxib Study ICardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention.N Engl J Med. 2005; 352: 1071-1080Crossref PubMed Scopus (1900) Google Scholar, 3Bresalier R.S. Sandler R.S. Quan H. et al.for the Adenomatous Polyp Prevention on Vioxx Trial InvestigatorsCardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial.N Engl J Med. 2005; 352: 1092-1102Crossref PubMed Scopus (2296) Google Scholar, 4Andersohn F. Schade R. Suissa S. Garbe E. Cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs and the risk of ischemic stroke: a nested case-control study.Stroke. 2006; 37: 1725-1730Crossref PubMed Scopus (87) Google Scholar As such, substantial concern has turned to the cerebrovascular safety related to NSAID use. In particular, current clinical guidelines discourage the use of NSAIDs in patients with previous history of cerebrovascular disease as well as those at high risk for cerebrovascular harm.5Antman E.M. Bennett J.S. Daugherty A. et al.for the American Heart AssociationUse of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association.Circulation. 2007; 115: 1634-1642Crossref PubMed Scopus (696) Google Scholar Patients on dialysis are a susceptible population for cerebrovascular disease. For example, Toyoda et al.6Toyoda K. Fujii K. Ando T. et al.Incidence, etiology, and outcome of stroke in patients on continuous ambulatory peritoneal dialysis.Cerebrovasc Dis. 2004; 17: 98-105Crossref PubMed Scopus (29) Google Scholar, 7Toyoda K. Fujii K. Fujimi S. et al.Stroke in patients on maintenance hemodialysis: a 22-year single-center study.Am J Kidney Dis. 2005; 45: 1058-1066Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar provided supportive evidence that stroke is common in patients with end-stage kidney disease who are undergoing hemodialysis or peritoneal dialysis). Seliger et al.8Seliger S.L. Gillen D.L. Longstreth Jr., W.T. et al.Elevated risk of stroke among patients with end-stage renal disease.Kidney Int. 2003; 64: 603-609Abstract Full Text Full Text PDF PubMed Scopus (337) Google Scholar has reported that incidence of stroke (both ischemic and hemorrhagic stroke) in patients on dialysis is particularly higher than that in the general population. However, whereas some attention has been given to the safety of NSAID use in patients with renal function issue,9Kristensen S.L. Fosbol E.L. Kamper A.L. et al.Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation: a nationwide study.Pharmacoepidemiol Drug Saf. 2012; 21: 428-434Crossref PubMed Scopus (14) Google Scholar, 10Hsu C.C. Wang H. Hsu Y.H. et al.Use of nonsteroidal anti-inflammatory drugs and risk of chronic kidney disease in subjects with hypertension: Nationwide Longitudinal Cohort Study.Hypertension. 2015; 66: 524-533Crossref PubMed Scopus (49) Google Scholar whether NSAIDs use exerts an effect on elevated risk of stroke in dialysis patients remains largely unclear. To determine the effect of NSAID use on risk of stroke in dialysis patients, we carried out a case-crossover study using nationwide medical claims data in Taiwan to evaluate the associations between NSAID use and risk of stroke (either ischemic or hemorrhagic) in dialysis patients. The data used in this study were derived from the Longitudinal Health Insurance Database, which comprises the reimbursement medical claims data of Taiwan’s National Health Insurance Program, which contains demographic characteristics, disease diagnoses, ambulatory care and inpatient claims data, and prescription records from National Health Insurance Program enrollees. Of note, the Longitudinal Health Insurance Database was constructed by randomly selecting 1 million enrollees from the Registry for Beneficiaries of the National Health Insurance Program in 2000, 2005, and 2010, respectively. Thus, a total of 3 million enrollees were included in this study. All medical claims data from 1 January 2000 to 31 December 2012 were included as the data source. The study protocol was approved by the Institutional Review Board of the National Health Research Institutes, Taiwan. We first identified dialysis patients; that is, patients with a primary diagnosis of end-stage renal disease under International Classification of Diseases, 9th revision, Clinical Modification code 585 and who receive treatment using hemodialysis, peritoneal dialysis, or hemofiltration. Among those patients, we further identified study participants as patients with a hospitalization record for a primary diagnosis of a stroke event (International Classification of Diseases, 9th revision, Clinical Modification codes 433, 434, and 436 for ischemic stroke and 430 and 431 for hemorrhagic stroke). The index date was defined as the date that the participant was diagnosed as having a hospitalized medical record of a stroke. Patents were excluded based on the following criteria: (i) age <20 years in the first claims record of dialysis during the study period; (ii) previous inpatient admissions or outpatient visits for stroke during the period from 2000 to 2002; (iii) diagnosis of stroke prior to initiation of initiation; (iv) sex data were missing; and (v) previous diagnosis of trauma or acute myocardial infarction before the diagnosis of stroke. As a result, a total of 1190 dialysis patients, who also had incident cases of stroke from 2003 to 2012, were identified and included for further analyses in this study. Figure 1 presents the detailed flow chart regarding inclusions and exclusions of the study participants. We obtained information on NSAID exposure according to prescription records in the National Health Insurance Research Database (NHIRD). Each prescription record in the NHIRD contains the types of prescribed drugs, time of prescription, and duration of drug supply and dosage. We identified all prescription records for NSAIDs based on the Anatomic Therapeutic Chemical code M01A, which was developed by the World Health Organization Collaborating Centre.11Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC Classification and DDD Assignment. Oslo, Norway: World Health Organization, 2009.Google Scholar In detail, the following NSAIDs were investigated in this study: (i) selective cyclooxygenase 2 (COX-2) inhibitors: celecoxib and etoricoxib; and (ii) nonselective NSAIDs: salicylates, propionic acid derivatives, acetic acid derivatives, enolic acid derivatives, and anthranilic acid derivatives. In addition, the route of administration (oral or parenteral) for NSAID exposure was also examined in this study (Supplementary Table S1). The following time-varying covariates were included and adjusted for in the subsequent analyses: (i) concomitant medication use related to stroke, such as antihypertensive agents (β-blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, calcium-channel blockers, and loop diuretics), antidiabetic agents (insulin, sulfonylurea, thiazolidinediones, and glinides), statins, and anticoagulants (except for aspirin);12Chang C.H. Shau W.Y. Kuo C.W. et al.Increased risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nationwide case-crossover study.Stroke. 2010; 41: 1884-1890Crossref PubMed Scopus (71) Google Scholar and (ii) health care utilization, which was calculated as the number of outpatient visits during the case and control periods, respectively.13Chuang S.Y. Yu Y. Sheu W.H. et al.Association of short-term use of nonsteroidal anti-inflammatory drugs with stroke in patients with hypertension.Stroke. 2015; 46: 996-1003Crossref PubMed Scopus (15) Google Scholar We defined the case period as 1 to 30 days prior to the index date and the control period as 91 to 120 days prior to the index date for each study participant. This same definition for the case and control periods was used in previous studies regarding pharmacological properties of NSAIDs.12Chang C.H. Shau W.Y. Kuo C.W. et al.Increased risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nationwide case-crossover study.Stroke. 2010; 41: 1884-1890Crossref PubMed Scopus (71) Google Scholar, 14Gislason G.H. Jacobsen S. Rasmussen J.N. et al.Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction.Circulation. 2006; 113: 2906-2913Crossref PubMed Scopus (369) Google Scholar In this study, we applied a population-based, case-crossover study design to determine the relationship between NSAID use and the risk of stroke, including ischemic and hemorrhagic stroke among dialysis patients. We performed conditional logistic regression models to compare the effect of NSAID use on stroke between case and control periods. Crude and adjusted odd ratios (ORs) were computed, with and without adjustment for the above-mentioned factors of time-varying medications and health care utilization. In addition to overall NSAID use, further analyses were conducted for the use of selective, nonselective, and each individual NSAID, respectively, and for the route of administration (oral or parenteral) for NSAIDs, with and without adjustment for covariates. We also carried out subgroup analyses to examine the modifying effects of various characteristics, including age, sex, Charlson comorbidity index (CCI) score,15Charlson M.E. Pompei P. Ales K.L. MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383Abstract Full Text PDF PubMed Scopus (34434) Google Scholar heart disease, type 2 diabetes mellitus, and anticoagulant use. Moreover, sensitivity analyses were applied to test the robustness of the results. That is, we repeated the analyses using 3 alternative time windows: (i) 1 to 15 days before the index date as the case period and 31 to 45 days before the index date as the control period; (ii) 1 to 30 days before the index date as the case period and 61 to 90 days before the index date as the control period; and (iii) 1 to 30 days as the case period and 121 to 150 days as the control period. We declared statistical significance using a P value <0.05. All of the analyses were performed using SAS version 9.2 for Windows (SAS Institute, Cary, NC). We identified a total of 1190 dialysis patients who were hospitalized for incident ischemic or hemorrhagic stroke during the period from 2003 to 2012. The mean age at the onset of stroke was 62.9 ± 12.2 years, and 51.3% of the study subjects were women. Among them, 78.6% of dialysis patients were hospitalized for ischemic stroke and 21.4% were hospitalized for hemorrhagic stroke. Detailed information regarding demographic characteristics, concomitant medication use CCI score, and health care utilization are reported in Table 1.Table 1Demographic and clinical characteristics of the study subjectsCharacteristicsn%Demographics Age group (yr)20–6461351.51≥6557748.49 SexWomen61151.34Men57948.66Concomitant medication Antihypertensives21618.15 Statins29324.62 Insulin35730.00 Sulfonylurea24520.59 Thiazolidinediones766.39 Glinides18615.63 β-blockers59950.34 ACE-I/ARB54445.71 Calcium-channel blockers77665.21 Loop diuretics37031.09 Vitamin K antagonists473.95 Nonaspirin antiplatelet agents38532.35 Low-dose aspirin00 Anticoagulants59550.00Charlson Comorbidity Index score 1–333828.40 ≥485271.60Health care use during 1 year before stroke No. of outpatient visits020.171–2660951.18≥2757948.66 No. of inpatient visits049941.93129324.62≥239833.45Dialysis modality HD111093.28 PD806.72Dialysis duration prior to strokeMean ± SD HD11101079.15 ± 926.11 PD801115.15 ± 879.89ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; HD, hemodialysis; PD, peritoneal dialysis. Open table in a new tab ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; HD, hemodialysis; PD, peritoneal dialysis. Table 2 shows the association of NSAID use with the risk of overall stroke, ischemic stroke, and hemorrhagic stroke, respectively. The results suggest that overall NSAIDs use during the 30 days prior to the stroke index date was associated with an increased risk of stroke and ischemic stroke, after controlling for confounding factors (adjusted OR [AOR]: 1.31; 95% confidence interval [CI]: 1.03–1.66 for stroke; AOR: 1.34; 95% CI: 1.02–1.77 for ischemic stroke). When classifying overall NSAIDs into selective, nonselective, and individual NSAIDs, positive associations with stroke were found for the use of nonselective NSAIDs (AOR: 1.27; 95% CI: 1.00–1.61), propionic acid (AOR: 2.14; 95% CI: 1.16–3.95), and anthranilic acid (AOR: 1.94; 95% CI: 1.08–3.49), separately. Additionally, a significant association with ischemic stroke was found for the use of propionic acid (AOR: 2.34; 95% CI: 1.14–4.82). We also observed that both oral and parenteral NSAID administration were significantly associated with stroke, but a positive association with ischemic stroke was only found for parenteral NSAID administration (Table 2). Because blood pressure data were not available in the present study, we classified study subjects into 2 groups: subjects with and without hypertension, separately; we repeated the analysis by using patients with and without hypertension, respectively. The results were comparable between patients with and without hypertension (Supplementary Table S2A and 2B).Table 2Risk of stroke, ischemic stroke, and hemorrhagic stroke in relation to NSAID use among patients with renal dialysisCase period (1-30 days before index date)Control period (91-120 days before index date)CrudeAdjustedaCovariates adjusted in the conditional logistic regression models include antihypertensive (β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium-channel blockers, and loop diuretics), antidiabetic agents (insulin, sulfonylurea, thiazolidinediones, and glinides), statins, and anticoagulants (except for aspirin) and number of outpatient visits.n%n%OR95% CIOR95% CIStroke (n = 1,190)NSAIDs overall44537.3937531.511.57bP < 0.05 is in bold.(1.25–1.97)1.31(1.03–1.66) Selective473.95413.451.26(0.73–2.18)1.18(0.67–2.09) Nonselective41935.2135329.661.53(1.22–1.91)1.27(1.00–1.61)Salicylates20717.3919216.131.24(0.89–1.74)1.11(0.78–1.59)Propionic acid514.29272.272.50(1.40–4.46)2.14(1.16–3.95)Acetic acid16613.9512610.591.49(1.13–1.98)1.16(0.86–1.57)Enolic acid544.54413.451.46(0.91–2.37)1.33(0.80–2.20)Anthranilic acid453.78211.762.33(1.34–4.05)1.94(1.08–3.49) Oral41434.7935629.921.47(1.17–1.85)1.23(0.96–1.56) Parenteral766.39403.362.29(1.47–3.56)1.94(1.22–3.06)Ischemic stroke (n = 935)NSAIDs overall36138.6130032.091.66(1.28–2.15)1.34(1.02–1.77) Selective414.39373.961.20(0.66–2.17)1.10(0.59–2.07) Nonselective33936.2628230.161.59(1.24–2.06)1.28(0.97–1.68)Salicylates17318.5015716.791.31(0.91–1.89)1.15(0.77–1.70)Propionic acid404.28192.032.91(1.47–5.77)2.34(1.14–4.82)Acetic acid13314.2210210.911.48(1.08–2.04)1.13(0.80–1.59)Enolic acid485.13353.741.57(0.93–2.64)1.38(0.79–2.41)Anthranilic acid303.21171.821.87(1.00–3.50)1.58(0.80–3.12) Oral33836.1528430.371.58(1.22–2.05)1.29(0.98–1.70) Parenteral606.42323.422.22(1.36–3.63)1.86(1.12–3.11)Hemorrhagic stroke (n = 255)NSAIDs overall8432.947529.411.29(0.81–2.06)1.15(0.69–1.90) Selective62.3541.571.67(0.40–6.97)1.55(0.36–6.75) Nonselective8031.377127.841.31(0.81–2.13)1.18(0.70–2.00)Salicylates3413.333513.730.91(0.39–2.14)0.85(0.33–2.18)Propionic acid114.3183.141.60(0.52–4.89)1.54(0.43–5.48)Acetic acid3312.94249.411.53(0.83–2.82)1.27(0.66–2.45)Enolic acid62.3562.351.00(0.29–3.45)1.00(0.28–3.65)Anthranilic acid155.8841.574.67(1.34–16.24)6.44(1.38–29.98)Oral7629.807228.241.13(0.69–1.85)1.04(0.61–1.77)Parenteral166.2783.142.60(0.93–7.29)1.97(0.66–5.88)CI, confidence interval; NSAID, nonsteroidal anti-inflammatory drug; OR, odds ratio.a Covariates adjusted in the conditional logistic regression models include antihypertensive (β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium-channel blockers, and loop diuretics), antidiabetic agents (insulin, sulfonylurea, thiazolidinediones, and glinides), statins, and anticoagulants (except for aspirin) and number of outpatient visits.b P < 0.05 is in bold. Open table in a new tab CI, confidence interval; NSAID, nonsteroidal anti-inflammatory drug; OR, odds ratio. Figure 2a shows the relationships between NSAIDs use and the risks of overall stroke and ischemic and hemorrhagic stroke in dialysis patients, stratified by age, sex, and various clinical conditions. The results indicated that NSAIDs use significantly elevated the risk of stroke and ischemic stroke among patients aged 20 to 64 years, with a CCI score higher than 3, and with anticoagulants use, but no significant interaction was found between NSAIDs use and age, CCI score, or anticoagulants use, individually, was found. Similar results were observed when including patients on peritoneal dialysis (Figure 2b). In addition, when we also examined the interaction of NSAIDs use with age, sex, and various clinical conditions, separately, we did not find any significant interactions. Likely, we examined the age effect by adding an interaction term between age and NSAID use in a regression model but found no interaction. Sensitivity analysis was carried out using different time windows, specifically: 1 to 15 days for the case period and 31 to 45 days for the control period; 1 to 30 days for case period and 61 to 90 days for control period; and 1 to 30 days for case period and 121 to 150 days for control period, separately. No overt changes were found in relation to the associations between NSAID use and increased risks of overall, ischemic, and hemorrhagic stroke across the different time windows (Table 3).Table 3Risk of stroke, ischemic stroke, and hemorrhagic stroke in relation to NSAID use among patients with renal dialysis, based on different lengths for case and control periodsCase period 1-15 daysControl period 31-45 daysCase period 1-30 daysControl period 61-90 daysCase period 1-30 daysControl period 91-120 daysCase period 1-30 daysControl period 121-150 daysCOR (95% CI)AORaCovariates adjusted in the conditional logistic regression models include antihypertensives (β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium-channel blockers, and loop diuretics), antidiabetic agents (insulin, sulfonylurea, thiazolidinediones, and glinides), statins, and anticoagulants (except for aspirin), and number of outpatient visits. (95% CI)COR (95% CI)AOR (95% CI)COR (95% CI)AOR (95% CI)COR (95% CI)AOR (95% CI)StrokeNSAIDs overall1.65 (1.28–2.11)bP < 0.05 is in bold.1.36 (1.04–1.78)1.63 (1.29–2.05)1.37 (1.07–1.75)1.57 (1.25–1.97)1.31 (1.03–1.66)1.77 (1.42–2.20)1.52 (1.20–1.91) Selective0.94 (0.46–1.90)0.83 (0.40–1.72)1.37 (0.76–2.47)1.18 (0.64–2.18)1.26 (0.73–2.18)1.18 (0.67–2.09)1.26 (0.76–2.09)1.19 (0.70–2.02) Nonselective1.70 (1.31–2.19)1.39 (1.06–1.84)1.65 (1.30–2.08)1.37 (1.07–1.76)1.53 (1.22–1.91)1.27 (1.00–1.61)1.79 (1.44–2.24)1.52 (1.20–1.92)Salicylates1.34 (0.93–1.93)1.18 (0.79–1.76)1.50 (1.04–2.16)1.39 (0.95–2.05)1.24 (0.89–1.74)1.11 (0.78–1.59)1.32 (0.95–1.83)1.18 (0.83–1.68)Propionic acid2.00 (1.08–3.72)1.51 (0.79–2.87)1.59 (0.93–2.71)1.32 (0.75–2.32)2.50 (1.40–4.46)2.14 (1.16–3.95)1.72 (1.05–2.82)1.27 (0.76–2.15)Acetic acid2.20 (1.51–3.20)1.74 (1.18–2.57)1.58 (1.18–2.13)1.25 (0.92–1.71)1.49 (1.13–1.98)1.16 (0.86–1.57)1.65 (1.25–2.18)1.29 (0.96–1.73)Enolic acid1.15 (0.63–2.09)1.00 (0.54–1.86)1.71 (1.03–2.83)1.44 (0.85–2.43)1.46 (0.91–2.37)1.33 (0.80–2.20)1.74 (1.04–2.90)1.61 (0.94–2.76)Anthranilic acid1.14 (0.64–2.02)0.90 (0.49–1.64)1.30 (0.81–2.09)0.92 (0.56–1.53)2.33 (1.34–4.05)1.94 (1.08–3.49)2.56 (1.44–4.57)2.26 (1.23–4.13) Oral1.49 (1.15–1.92)1.22 (0.93–1.60)1.46 (1.15–1.84)1.23 (0.96–1.58)1.47 (1.17–1.85)1.23 (0.96–1.56)1.65 (1.32–2.06)1.41 (1.11–1.79) Parenteral3.69 (2.00–6.81)2.79 (1.48–5.26)2.76 (1.68–4.55)2.22 (1.32–3.74)2.29 (1.47–3.56)1.94 (1.22–3.06)2.65 (1.69–4.17)2.28 (1.42–3.67)Ischemic strokeNSAIDs overall1.93 (1.45–2.57)1.52 (1.11–2.08)1.71 (1.31–2.23)1.40 (1.06–1.86)1.66 (1.28–2.15)1.34 (1.02–1.77)1.79 (1.39–2.30)1.52 (1.16–1.98) Selective1.17 (0.54–2.52)0.97 (0.43–2.19)1.53 (0.80–2.94)1.29 (0.66–2.53)1.20 (0.66–2.17)1.10 (0.59–2.07)1.38 (0.79–2.42)1.27 (0.70–2.31) Nonselective1.95 (1.45–2.63)1.52 (1.10–2.10)1.73 (1.32–2.26)1.41 (1.06–1.88)1.59 (1.24–2.06)1.28 (0.97–1.68)1.79 (1.39–2.30)1.49 (1.14–1.95)Salicylates1.44 (0.95–2.16)1.16 (0.74–1.82)1.66 (1.11–2.48)1.50 (0.97–2.30)1.31 (0.91–1.89)1.15 (0.77–1.70)1.39 (0.97–2.00)1.25 (0.85–1.83)Propionic acid3.71 (1.61–8.56)2.78 (1.17–6.63)2.07 (1.09–3.92)1.61 (0.82–3.15)2.91 (1.47–5.77)2.34 (1.14–4.82)1.89 (1.07–3.34)1.26 (0.69–2.31)Acetic acid2.25 (1.48–3.41)1.69 (1.09–2.62)1.51 (1.09–2.10)1.19 (0.84–1.68)1.48 (1.08–2.04)1.13 (0.80–1.59)1.55 (1.13–2.11)1.21 (0.87–1.69)Enolic acid1.50 (0.76–2.95)1.38 (0.68–2.81)2.12 (1.19–3.77)1.71 (0.94–3.12)1.57 (0.93–2.64)1.38 (0.79–2.41)1.80 (1.04–3.11)1.67 (0.94–2.98)Anthranilic acid1.06 (0.54–2.10)0.77 (0.38–1.59)0.96 (0.56–1.67)0.67 (0.38–1.21)1.87 (1.00–3.50)1.58 (0.80–3.12)2.45 (1.22–4.95)2.40 (1.15–5.04) Oral1.73 (1.29–2.32)1.37 (0.99–1.88)1.55 (1.18–2.02)1.29 (0.97–1.72)1.58 (1.22–2.05)1.29 (0.98–1.70)1.66 (1.29–2.15)1.41 (1.08–1.85) Parenteral4.22 (2.04–8.73)3.01 (1.41–6.44)2.88 (1.63–5.08)2.19 (1.21–3.94)2.22 (1.36–3.63)1.86 (1.12–3.11)2.45 (1.49–4.03)2.17 (1.29–3.67)Hemorrhagic strokeNSAIDs overall0.97 (0.57–1.62)0.89 (0.50–1.60)1.38 (0.86–2.23)1.15 (0.68–1.96)1.29 (0.81–2.06)1.15 (0.69–1.90)1.69 (1.07–2.67)1.55 (0.92–2.61) Selective0.25 (0.03–2.24)0.14 (0.01–1.48)0.75 (0.17–3.35)0.66 (0.13–3.37)1.67 (0.40–6.97)1.55 (0.36–6.75)0.83 (0.25–2.73)0.67 (0.18–2.45) Nonselective1.04 (0.61–1.78)1.01 (0.55–1.87)1.39 (0.86–2.26)1.16 (0.67–1.99)1.31 (0.81–2.13)1.18 (0.70–2.00)1.82 (1.13–2.90)1.72 (1.00–2.95)Salicylates1.00 (0.43–2.31)0.97 (0.36–2.61)0.90 (0.37–2.22)0.87 (0.32–2.33)0.91 (0.39–2.14)0.85 (0.33–2.18)1.00 (0.45–2.23)0.97 (0.37–2.55)Propionic acid0.50 (0.15–1.66)0.47 (0.14–1.62)0.75 (0.26–2.16)0.52 (0.15–1.84)1.60 (0.52–4.89)1.54 (0.43–5.48)1.29 (0.48–3.45)1.08 (0.35–3.31)Acetic acid2.00 (0.86–4.67)1.91 (0.75–4.88)1.92 (0.98–3.76)1.49 (0.73–3.07)1.53 (0.83–2.82)1.27 (0.66–2.45)2.14 (1.14–4.04)1.99 (0.96–4.09)Enolic acid0.33 (0.07–1.65)0.26 (0.07–1.37)0.71 (0.23–2.25)0.59 (0.18–1.97)1.00 (0.29–3.45)1.00 (0.28–3.65)1.33 (0.30–5.96)1.39 (0.28–6.80)Anthranilic acid1.33 (0.46–3.84)1.57 (0.49–5.07)3.50 (1.15–10.63)3.57 (0.93–13.66)4.67 (1.34–16.24)6.44 (1.38–29.98)2.80 (1.01–7.77)2.59 (0.84–7.93) Oral0.85 (0.50–1.48)0.79 (0.43–1.45)1.20 (0.74–1.95)1.00 (0.58–1.72)1.13 (0.69–1.85)1.04 (0.61–1.77)1.59 (0.98–2.58)1.43 (0.84–2.44) Parenteral2.50 (0.78–7.96)2.28 (0.67–7.69)2.40 (0.85–6.81)2.08 (0.63–6.85)2.60 (0.93–7.29)1.97 (0.66–5.88)3.75 (1.25–11.30)3.46 (0.98–12.24)AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; NSAID, nonsteroidal anti-inflammatory drug.a Covariates adjusted in the conditional logistic regression models include antihypertensives (β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium-channel blockers, and loop diuretics), antidiabetic agents (insulin, sulfonylurea, thiazolidinediones, and glinides), statins, and anticoagulants (except for aspirin), and number of outpatient visits.b P < 0.05 is in bold. Open table in a new tab AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; NSAID, nonsteroidal anti-inflammatory drug. The results of this study suggest that the use of NSAIDs significantly increased the risk of stroke among dialysis patients. We found overall NSAID use to be associated with a 31% greater risk of stroke, after adjusting for confounding factors. In addition to overall NSAIDs, the use of nonselective and a certain number of individual nonselective NSAIDs also showed an adverse effect on elevated risk of stroke. A greater risk of stroke was found when delivering NSAIDs parenterally compared with using NSAIDs in oral form. Several studies have provided suggestive data that NSAID use is positively associated with the risk of stroke,12Chang C.H. Shau W.Y. Kuo C.W. et al.Increased risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nationwide case-crossover study.Stroke. 2010; 41: 1884-1890Crossref PubMed Scopus (71) Google Scholar, 16Haag M.D. Bos M.J. Hofman A. et al.Cyclooxygenase selectivity of nonsteroidal anti-inflammatory drugs and risk of stroke.Arch Intern Med. 2008; 168: 1219-1224Crossref PubMed Scopus (62) Google Scholar, 17Fosbol E.L. Olsen A.M. Olesen J.B. et al.Use of nonsteroidal anti-inflammatory drugs among healthy people and specific cerebrovascular safety.Int J Stroke. 2014; 9: 943-945Crossref PubMed Scopus (8) Google Scholar, 18Caughey G.E. Roughead E.E. Pratt N. et al.Stroke risk and NSAIDs: an Australian population-based study.Med J Aust. 2011; 195: 525-529Crossref PubMed Scopus (46) Google Scholar but limited studies have been conducted for assessing the cerebrovascular effects of NSAIDs in high-risk populations, especially Asian populations. To the best of our knowledge, the present study is among the few research investigations that has attempted to investigate the risk of stroke associated with selective and nonselective NSAIDs, individually, in dialysis patients. Our results are in line with previous observational studies conducted in different ethnic populations. For example, in a nested case-control study using a United Kingdom cohort, Andersohn et al.4Andersohn F. Schade R. Suissa S. Garbe E. Cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs and the risk of ischemic stroke: a nested case-control study.Stroke. 2006; 37: 1725-1730Crossref PubMed Scopus (87) Google Scholar examined the association between the use of COX-2 selective NSAIDs and ischemic stroke. Their results showed that the use of a certain kind of individual COX-2 selective" @default.
• W2575271605 created "2017-01-26" @default.
• W2575271605 creator A5016184067 @default.
• W2575271605 creator A5053254960 @default.
• W2575271605 creator A5054227070 @default.
• W2575271605 creator A5066985721 @default.
• W2575271605 creator A5075329401 @default.
• W2575271605 creator A5082977927 @default.
• W2575271605 creator A5087575692 @default.
• W2575271605 date "2017-05-01" @default.
• W2575271605 modified "2023-10-08" @default.
• W2575271605 title "Association of Nonsteroidal Anti-inflammatory Drug Use With Stroke Among Dialysis Patients" @default.
• W2575271605 cites W1803320375 @default.
• W2575271605 cites W1867240762 @default.
• W2575271605 cites W1971207139 @default.
• W2575271605 cites W1971289909 @default.
• W2575271605 cites W1971855890 @default.
• W2575271605 cites W1972821304 @default.
• W2575271605 cites W1974032428 @default.
• W2575271605 cites W1974256506 @default.
• W2575271605 cites W1995543952 @default.
• W2575271605 cites W2000445173 @default.
• W2575271605 cites W2004848147 @default.
• W2575271605 cites W2004916700 @default.
• W2575271605 cites W2006577697 @default.
• W2575271605 cites W2010818945 @default.
• W2575271605 cites W2018035901 @default.
• W2575271605 cites W2021580807 @default.
• W2575271605 cites W2040493457 @default.
• W2575271605 cites W2042725485 @default.
• W2575271605 cites W2062159035 @default.
• W2575271605 cites W2065689558 @default.
• W2575271605 cites W2070461740 @default.
• W2575271605 cites W2080195990 @default.
• W2575271605 cites W2098504866 @default.
• W2575271605 cites W2099995466 @default.
• W2575271605 cites W2100024933 @default.
• W2575271605 cites W2108413367 @default.
• W2575271605 cites W2114405303 @default.
• W2575271605 cites W2114818190 @default.
• W2575271605 cites W2126853519 @default.
• W2575271605 cites W2129584145 @default.
• W2575271605 cites W2134522165 @default.
• W2575271605 cites W2134987486 @default.
• W2575271605 cites W2143622239 @default.
• W2575271605 cites W2148193549 @default.
• W2575271605 cites W2158131645 @default.
• W2575271605 cites W2158968701 @default.
• W2575271605 cites W2886439199 @default.
• W2575271605 cites W4239471829 @default.
• W2575271605 cites W4290747706 @default.
• W2575271605 cites W4377862878 @default.
• W2575271605 cites W2119800046 @default.
• W2575271605 doi "https://doi.org/10.1016/j.ekir.2017.01.004" @default.
• W2575271605 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/5678629" @default.
• W2575271605 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/29142967" @default.
• W2575271605 hasPublicationYear "2017" @default.
• W2575271605 type Work @default.
• W2575271605 sameAs 2575271605 @default.
• W2575271605 citedByCount "9" @default.
• W2575271605 countsByYear W25752716052018 @default.
• W2575271605 countsByYear W25752716052019 @default.
• W2575271605 countsByYear W25752716052020 @default.
• W2575271605 countsByYear W25752716052021 @default.
• W2575271605 countsByYear W25752716052022 @default.
• W2575271605 countsByYear W25752716052023 @default.
• W2575271605 crossrefType "journal-article" @default.
• W2575271605 hasAuthorship W2575271605A5016184067 @default.
• W2575271605 hasAuthorship W2575271605A5053254960 @default.
• W2575271605 hasAuthorship W2575271605A5054227070 @default.
• W2575271605 hasAuthorship W2575271605A5066985721 @default.
• W2575271605 hasAuthorship W2575271605A5075329401 @default.
• W2575271605 hasAuthorship W2575271605A5082977927 @default.
• W2575271605 hasAuthorship W2575271605A5087575692 @default.
• W2575271605 hasBestOaLocation W25752716051 @default.
• W2575271605 hasConcept C126322002 @default.
• W2575271605 hasConcept C127413603 @default.
• W2575271605 hasConcept C2778484676 @default.
• W2575271605 hasConcept C2779978075 @default.
• W2575271605 hasConcept C2780035454 @default.
• W2575271605 hasConcept C2780645631 @default.
• W2575271605 hasConcept C71924100 @default.
• W2575271605 hasConcept C78519656 @default.
• W2575271605 hasConcept C98274493 @default.
• W2575271605 hasConceptScore W2575271605C126322002 @default.
• W2575271605 hasConceptScore W2575271605C127413603 @default.
• W2575271605 hasConceptScore W2575271605C2778484676 @default.
• W2575271605 hasConceptScore W2575271605C2779978075 @default.
• W2575271605 hasConceptScore W2575271605C2780035454 @default.
• W2575271605 hasConceptScore W2575271605C2780645631 @default.
• W2575271605 hasConceptScore W2575271605C71924100 @default.
• W2575271605 hasConceptScore W2575271605C78519656 @default.
• W2575271605 hasConceptScore W2575271605C98274493 @default.
• W2575271605 hasIssue "3" @default.
• W2575271605 hasLocation W25752716051 @default.
• W2575271605 hasLocation W25752716052 @default.
• W2575271605 hasLocation W25752716053 @default.
• W2575271605 hasLocation W25752716054 @default.

• next