Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study

Abstract

BACKGROUND Acetaminophen is the most widely used analgesic today. A recent systematic review found increased adverse events and mortality at therapeutic dosage. Our aim was to challenge these results in a large sample of older adults living in nursing homes (NHs). DESIGN Prospective study using data from the Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators project (IQUARE), a multicenter, individually tailored, nonrandomized controlled trial in NHs across southwestern France. SETTING/PARTICIPANTS We studied data from 5429 participants living in 175 NHs (average age, 86.1 ± 8.1 years; 73.9% women). MEASUREMENTS All prescriptions obtained at baseline were analyzed by a pharmacist for acetaminophen use as stand‐alone or associated. Myocardial infarction (MI) and strokes were reported from participants' medical records at 18‐month follow‐up. Dates of death were obtained. Data collection was done through an online questionnaire at baseline and at 18 months by NH staff. Analyses were realized in our total population and a population matched on propensity score of acetaminophen intake. Six models were run for each outcome. RESULTS A total of 2239 participants were taking, on average, 2352 ± 993 mg of acetaminophen daily. Results for mortality were: hazard ratio (HR) = 0.97 (95% confidence interval [CI] = 0.86‐1.10). No associations between acetaminophen intake and the risk of mortality or MI were found. In one of our models, acetaminophen intake was associated with a significant increased risk of stroke in diabetic subjects (OR = 3.19; 95% CI = 1.25‐8.18; P = .0157). [Correction added March 16, 2019, after first publication online. In the previous sentence, “HR” was mistakenly used instead of “OR”.] CONCLUSION Despite old age, polypharmacy, and polymorbidity, acetaminophen was found safe for most, but not all, of our NH study population. Pain management in NHs is a health priority, and acetaminophen remains a good therapeutic choice as a first‐line analgesic. More studies are needed on older diabetic patients.

Paracetamol as first line for treatment of knee and hip osteoarthritis

“…That paracetamol had statistically significant benefits for pain and physical function (despite not achieving MCID thresholds; see the online supplementary table 1), coupled with its good harms profile indicate the drug should not be jettisoned as one of the first-line treatments for managing pain in the management of OA. Indeed, a recent large prospective study of elderly subjects (n=5429) concluded that ‘despite polypharmacy and polymorbidity’, acetaminophen (paracetamol) remains a first-line analgesic for managing pain 7…”

Analgesic therapy and a problem of comorbidity

“…Интересные данные приводят Р. Girard и соавт. [30], которые исследовали влияние приема ПАР на риск кардиоваскулярных катастроф у 5429 пожилых французов (средний возраст 86,1±8,1 года), нуждавшихся в уходе на дому. Из них 2239 регулярно принимали ПАР.…”

Reply to Acetaminophen Use and Stroke Risk

“…Recently, Roberts et al conducted a meta‐analysis that found that users of acetaminophen had an increased risk of stroke and myocardial infarction . Our aim was to explore these results in a geriatric setting . Thus, we conducted a study on a population of 6275 older persons living in nursing homes over an 18‐month period.…”