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Choosing and using non‐steroidal anti‐inflammatory drugs in haemophilia
Author(s) -
Arachchillage D. R. J.,
Makris M.
Publication year - 2016
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.12805
Subject(s) - medicine , analgesic , haemophilia , population , arthropathy , arthritis , disease , osteoarthritis , pharmacology , surgery , alternative medicine , environmental health , pathology
The management of pain and inflammation in haemophilic arthropathy is challenging due to the lack of anti‐inflammatory analgesic agents perfectly suitable for this population. Non‐steroidal anti‐inflammatory drugs ( NSAID s) are widely used in the management of arthritis due to their analgesic and anti‐inflammatory effects. Their use in persons with haemophilia ( PWH ), however, is limited due to increased risk of bleeding mainly from the upper gastrointestinal ( UGI ) tract. Cyclooxygenase‐2 ( COX ‐2) selective NSAID s which have comparable analgesic effect to traditional NSAID s ( tNSAID s) but with less UGI bleeding have been considered to be a suitable option for treatment of haemophilic arthropathy. COX ‐2 inhibitors, however, have an increased in the risk of cardiovascular ( CV ) disease. Although the atherosclerotic burden in PWH is similar to that in the general population, the risk of CV ‐related deaths is lower. PWH have a higher risk of GI bleeding and lower risk of thrombotic disease compared to general population. Therefore, when PWH require anti‐inflammatory/analgesic agents, it seems reasonable to use lowest dose of COX ‐2 inhibitors for the shortest period together with a proton pump inhibitor. Helicobacter pylori infection should be tested for and eradicated prior to starting NSAID treatment in PWH . Furthermore, regular blood pressure and renal function test monitoring is required during COX ‐2 inhibitor treatment.