NSAID complications: the balance of risks

The aim of this thesis is to promote safe pharmacotherapy with nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are among the world’s most prescribed drugs, being used on a daily basis by millions of people for effective relief of pain, fever and inflammation. However, NSAID treatment is associated with severe treatment side effects and complications, with significant morbidity, mortality, and costs. Most feared among these complications are bleeding and perforated gastroduodenal ulcers, and serious cardiovascular events such as myocardial infarction and stroke. This thesis addresses these serious NSAID treatment complications, delves into their underlying pathophysiological mechanisms, tries to paint a clearer picture of those at risk, and studies the effectiveness of possible preventive strategies. Over the last decade, different strategies have been developed to help prevent NSAID treatment associated gastroduodenal ulcers. Unfortunately, that which is good for the gastrointestinal risk may be bad for the cardiovascular risk, and vice versa. For physicians the challenge ahead is to learn to balance these risks when prescribing NSAIDs to individual patients.