Common Painkillers Tied to Blood Clot Risk, Study Suggests

 

WEDNESDAY Sept. 24, 2014, 2014 -- People who use painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) -- which include aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) -- may be at increased risk for potentially deadly blood clots, a new study suggests.

But the study only showed an association between use of the painkillers and higher clotting risk; it did not prove cause-and-effect.

The researchers analyzed the results of six studies involving more than 21,000 cases of a type of blood clot called a venous thromboembolism (VTE).

These clots include deep vein thrombosis (a clot in the leg) and pulmonary embolism (a clot in the lungs).

Reporting online Sept. 24 in Rheumatology, the analysis found that people who used NSAIDs had an 80 percent higher risk for venous clots.

"Our results show a statistically significant increased VTE risk among NSAID users. Why NSAIDs may increase the risk of VTE is unclear," study lead author Patompong Ungprasert, of Bassett Medical Center in Cooperstown, N.Y., said in a journal news release.

"Physicians should be aware of this association and NSAIDs should be prescribed with caution, especially in patients already at a higher risk of VTE," the researcher added.

Ungprasert noted that all types of NSAIDs were evaluated as one group, but not all types of NSAIDs may boost the risk of VTE.

Two experts said the findings are in keeping with prior research.

"It is not entirely surprising that NSAIDs are again implicated in causing clot-related illness," said Dr. Steven Carsons, chief of the division of rheumatology, allergy and immunology at Winthrop-University Hospital in Mineola, N.Y.

He pointed to the case of Vioxx, a powerful NSAID painkiller that was withdrawn from the market in 2004, after studies found a higher risk of heart attack and stroke in users.

The new study "makes a compelling case for further study and clinical surveillance for venous clotting events in those patients taking NSAIDs," Carsons said. However, he stressed that the study could not pinpoint which types of NSAIDs might pose the greatest risk, or which type of patients might be most vulnerable.

According to Carsons, "aspirin, the 'original' NSAID, has sufficient anti-clotting properties to be effective for prevention of VTEs, and most studies show that naproxen (Aleve) -- a common prescribed and over-the-counter NSAID -- carries no additional clotting risk."

Dr. Suzanne Steinbaum is a preventive cardiologist at Lenox Hill Hospital in New York City. She said that "without discerning which NSAIDS are more safe than others, this study shows the potential increase in VTE. It is important that both physicians and patients understand this risk, especially for those people who are already at risk for VTE."

More information

The American Academy of Family Physicians has more about deep vein thrombosis.

 

Medical discovery first step on path to new painkillers

 

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A major medical discovery by scientists at The University of Nottingham could lead to the development of an entirely new type of painkiller.

A drug resulting from the research, published in the journal Neurobiology of Disease, would offer new hope to sufferers of chronic pain conditions such as traumatic nerve injury, for which few effective painkillers are currently available.

The work, led by Dr Lucy Donaldson in the University's School of Life Sciences, in collaboration with David Bates, Professor of Oncology in the University'sCancer Biology Unit, focuses on a signal protein called vascular endothelial growth factor (VEGF).

VEGF controls the re-growth of blood vessels in tissues which have been damaged by injury. It is a widely targeted compound for cancer, eye disease and other illnesses in which abnormal blood vessel growth occurs.

Drugs are used to inhibit the VEGF in cancer, which can otherwise lead to the formation of new blood vessels that provide oxygen and nutrients to tumours.

Professor Bates and colleagues had previously discovered in 2002 that VEGF comes in two forms and acts like a switch -- one which turns on the growth of blood vessels and another that blocks growth.

Pain prevention

However, this latest research has shown for the first time that these two forms of VEGF not only act on blood vessels but also differently affect the sensory nerves that control pain.

The academics discovered that the VEGF that promotes blood vessel growth causes pain, while the other, which inhibits blood vessel growth, prevents pain.

The study has centred on understanding how these two types of VEGF work and why the body makes one form rather than the other.

The academics have been able to switch from the pain stimulating form to the pain inhibiting VEGF in animal models in the laboratory and are now investigating compounds to replicate this in humans. It is thought these compounds could form the basis for new drugs to be tested in humans in clinical trials.

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Story Source:

The above story is based on materials provided by University of Nottingham. Note: Materials may be edited for content and length.

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Journal Reference:

1. R.P. Hulse, N. Beazley-Long, J. Hua, H. Kennedy, J. Prager, H. Bevan, Y. Qiu, E.S. Fernandes, M.V. Gammons, K. Ballmer-Hofer, A.C. Gittenberger de Groot, A.J. Churchill, S.J. Harper, S.D. Brain, D.O. Bates, L.F. Donaldson. Regulation of alternative VEGF-A mRNA splicing is a therapeutic target for analgesia. Neurobiology of Disease, 2014; 71: 245 DOI: 10.1016/j.nbd.2014.08.012

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