Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study

Background Pain is a major issue in our aging society. Dipyrone (metamizole) is one of the most frequently used analgesics. Additionally, it has been shown to impair pharmacodynamic response to aspirin as measured by platelet function tests. However, it is not known how this laboratory effect transl...

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Autores principales:	Amin Polzin, Lisa Dannenberg, Carolin Helten, Martin Pöhl, Daniel Metzen, Philipp Mourikis, Christof Dücker, Ursula Marschall, Helmut L’Hoest, Beata Hennig, Saif Zako, Kajetan Trojovsky, Tobias Petzold, Christian Jung, Bodo Levkau, Tobias Zeus, Karsten Schrör, Thomas Hohlfeld, Malte Kelm
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	aggregation aspirin co‐medication dipyrone platelet activation platelet inhibition Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/46863831286544e9afcf8e597f1baae2
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spelling	oai:doaj.org-article:46863831286544e9afcf8e597f1baae22021-11-16T10:22:44ZExcess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study10.1161/JAHA.121.0222992047-9980https://doaj.org/article/46863831286544e9afcf8e597f1baae22021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.022299https://doaj.org/toc/2047-9980Background Pain is a major issue in our aging society. Dipyrone (metamizole) is one of the most frequently used analgesics. Additionally, it has been shown to impair pharmacodynamic response to aspirin as measured by platelet function tests. However, it is not known how this laboratory effect translates to clinical outcome. Methods and Results We conducted a nationwide analysis of a health insurance database in Germany comprising 9.2 million patients. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting analysis was conducted to investigate the rate of mortality, myocardial infarction, and stroke/transient ischemic attack between patients on aspirin‐dipyrone co‐medication compared with aspirin‐alone medication. Permanent aspirin‐alone medication was given to 26,200 patients, and 5946 patients received aspirin–dipyrone co‐medication. In the inverse probability of treatment weighted sample, excess mortality in aspirin–dipyrone co‐medicated patients was observed (15.6% in aspirin‐only group versus 24.4% in the co‐medicated group, hazard ratio [HR], 1.66 [95% CI, 1.56–1.76], P<0.0001). Myocardial infarction and stroke/transient ischemic attack were increased as well (myocardial infarction: 1370 [5.2%] versus 355 [5.9%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.18 [95% CI, 1.05–1.32]; P=0.0066, relative risk [RR], 1.14; number needed to harm, 140. Stroke/transient ischemic attack, 1901 [7.3%] versus 506 [8.5%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.22 [95% CI, 1.11–1.35]; P<0.0001, RR, 1.17, number needed to harm, 82). Conclusions In this observational, nationwide analysis, aspirin and dipyrone co‐medication was associated with excess mortality. This was in part driven by ischemic events (myocardial infarction and stroke), which occurred more frequently in co‐medicated patients as well. Hence, dipyrone should be used with caution in aspirin‐treated patients for secondary prevention.Amin PolzinLisa DannenbergCarolin HeltenMartin PöhlDaniel MetzenPhilipp MourikisChristof DückerUrsula MarschallHelmut L’HoestBeata HennigSaif ZakoKajetan TrojovskyTobias PetzoldChristian JungBodo LevkauTobias ZeusKarsten SchrörThomas HohlfeldMalte KelmWileyarticleaggregationaspirinco‐medicationdipyroneplatelet activationplatelet inhibitionDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	aggregation aspirin co‐medication dipyrone platelet activation platelet inhibition Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	aggregation aspirin co‐medication dipyrone platelet activation platelet inhibition Diseases of the circulatory (Cardiovascular) system RC666-701 Amin Polzin Lisa Dannenberg Carolin Helten Martin Pöhl Daniel Metzen Philipp Mourikis Christof Dücker Ursula Marschall Helmut L’Hoest Beata Hennig Saif Zako Kajetan Trojovsky Tobias Petzold Christian Jung Bodo Levkau Tobias Zeus Karsten Schrör Thomas Hohlfeld Malte Kelm Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study
description	Background Pain is a major issue in our aging society. Dipyrone (metamizole) is one of the most frequently used analgesics. Additionally, it has been shown to impair pharmacodynamic response to aspirin as measured by platelet function tests. However, it is not known how this laboratory effect translates to clinical outcome. Methods and Results We conducted a nationwide analysis of a health insurance database in Germany comprising 9.2 million patients. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting analysis was conducted to investigate the rate of mortality, myocardial infarction, and stroke/transient ischemic attack between patients on aspirin‐dipyrone co‐medication compared with aspirin‐alone medication. Permanent aspirin‐alone medication was given to 26,200 patients, and 5946 patients received aspirin–dipyrone co‐medication. In the inverse probability of treatment weighted sample, excess mortality in aspirin–dipyrone co‐medicated patients was observed (15.6% in aspirin‐only group versus 24.4% in the co‐medicated group, hazard ratio [HR], 1.66 [95% CI, 1.56–1.76], P<0.0001). Myocardial infarction and stroke/transient ischemic attack were increased as well (myocardial infarction: 1370 [5.2%] versus 355 [5.9%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.18 [95% CI, 1.05–1.32]; P=0.0066, relative risk [RR], 1.14; number needed to harm, 140. Stroke/transient ischemic attack, 1901 [7.3%] versus 506 [8.5%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.22 [95% CI, 1.11–1.35]; P<0.0001, RR, 1.17, number needed to harm, 82). Conclusions In this observational, nationwide analysis, aspirin and dipyrone co‐medication was associated with excess mortality. This was in part driven by ischemic events (myocardial infarction and stroke), which occurred more frequently in co‐medicated patients as well. Hence, dipyrone should be used with caution in aspirin‐treated patients for secondary prevention.
format	article
author	Amin Polzin Lisa Dannenberg Carolin Helten Martin Pöhl Daniel Metzen Philipp Mourikis Christof Dücker Ursula Marschall Helmut L’Hoest Beata Hennig Saif Zako Kajetan Trojovsky Tobias Petzold Christian Jung Bodo Levkau Tobias Zeus Karsten Schrör Thomas Hohlfeld Malte Kelm
author_facet	Amin Polzin Lisa Dannenberg Carolin Helten Martin Pöhl Daniel Metzen Philipp Mourikis Christof Dücker Ursula Marschall Helmut L’Hoest Beata Hennig Saif Zako Kajetan Trojovsky Tobias Petzold Christian Jung Bodo Levkau Tobias Zeus Karsten Schrör Thomas Hohlfeld Malte Kelm
author_sort	Amin Polzin
title	Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study
title_short	Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study
title_full	Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study
title_fullStr	Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study
title_full_unstemmed	Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study
title_sort	excess mortality in aspirin and dipyrone (metamizole) co‐medicated in patients with cardiovascular disease: a nationwide study
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/46863831286544e9afcf8e597f1baae2
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Excess Mortality in Aspirin and Dipyrone (Metamizole) Co‐Medicated in Patients With Cardiovascular Disease: A Nationwide Study

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