Coronary Events After Dispensing of Ibuprofen: A Propensity Score-Matched Cohort Study Versus Paracetamol in the French Nationwide Claims Database Sample

Abstract

There was no evidence for an increased risk of ACS in patients dispensed ibuprofen compared to paracetamol.

Ibuprofen and Paracetamol: Acceptably Safe for All?

“…In particular, this meta-analysis showed that use of ibuprofen for 8–30 days at doses > 1200 mg was particularly harmful (adjusted odds ratio 1.75). These findings suggest that NSAID users have a risk of cardiac events that depends primarily on drug dose and patient CV risk profile, a finding supported by the Doung et al [ 2 ] study.…”

“…In the current issue of Drug Safety , Duong et al [ 2 ] report hospital admissions for acute coronary syndrome (ACS), in a French claims database sample, that occurred within 3 months after the dispensing of ibuprofen or paracetamol. A cohort of 168,400 people prescribed 315,269 ibuprofen treatment episodes (TEs) were compared, using propensity score matching, with a cohort of 395,952 patients with 630,457 prescriptions for paracetamol TEs.…”

“…However, observational data suffer from channeling and other biases [ 4 ] such that high-risk patients are given the perceived safer CV drug (paracetamol) whereas low-risk patients are given the perceived riskier NSAID (ibuprofen). Indeed, age is a dominant CV risk factor and the subjects in the study by Doung et al [ 2 ] taking paracetamol were 10 years older than ibuprofen users.…”

“…The Doung et al [ 2 ] study appropriately matched the ibuprofen cohort with a paracetamol cohort to avoid protopathic and indication bias. However, paracetamol was chosen on the assumption of its low CV risk profile—an assumption that has been questioned.…”

Previous Drug Exposure in Patients Hospitalised for Acute Liver Injury: A Case-Population Study in the French National Healthcare Data System

“…Ideally one would want to have direct contact with the patient, knowing that even that is sometimes uncertain [45,46]. Though most claims databases cannot identify OTC drugs, in France over 84% of the paracetamol and 70% of analgesic strength ibuprofen is prescribed and identified in the database [31,32,47]. Drug dispensing is specific and precise, in that only commercial preparations are dispensed, indicating the exact number of tablets, and their individual strength, so that the total quantity of drug that is dispensed in known.…”