Objective: To determine the risk of stroke associated with non-steroidal I anti-inflammatory drug (NSAID) use.Design, setting and participants: Retrospective cohort study of 162 065 I Australian veterans with incident dispensing of an NSAID between 1 January 2001 and 31 December 2008, using prescription event sequence symmetry analysis.Main outcome measures: Hospitalisation for stroke, ischaemic stroke or haemorrhagic stroke.Results: The absolute risk of stroke was low: 7.1/1000 people/year. Incident use I of NSAIDs was associated with a 1.88 times increased risk (95% CI, 1.70-2.08) of hospitalisation for stroke (ischaemic or haemorrhagic) following first ever dispensing of an NSAID. This equates to an increased absolute risk of 13.4 strokes/1000 people/year. Significant positive associations between starting an NSAID and having a hospitalisation for stroke were found for most NSAIDs, with adjusted sequence ratios ranging from 1.44 (95% CI, 1.16-1.80) for indomethacin to 1.80 (95% CI, 1.59-2.04) for rofecoxib.Conclusions: Incident use of NSAIDs was associated with an increased risk of I stroke. Increased awareness of the potential for serious adverse cardiovascular events, together with individual assessment of cardiovascular risk, careful deliberation of the balance between risk and benefits and appropriate I supervision, is required when initiating NSAID therapy.
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