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Table 2 Clinicians guide to anti-inflammatory therapy

From: New horizons and perspectives in the treatment of osteoarthritis

  No or low gastrointestinal risk NSAID gastrointestinal risk
No cardiovascular risk (without aspirin) Nonselective NSAID (cost consideration) COX-2 selective inhibitor or Nonselective NSAID + PPI Or COX-2 selective inhibitor + PPI for patients with previous gastrointestinal bleeding
Cardiovascular riska (with aspirin) Naproxenb Addition of PPI if gastrointestinal risk of aspirin/NSAID combination warrants gastroprotection Add PPI irrespective of NSAID COX-2 selective inhibitor + PPI for those with previous gastrointestinal bleeding
  1. aContraindications to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) include heart failure and treatment of perioperative pain in the setting of coronary artery bypass surgery. Contraindications for selective cyclo-oxygenase (COX)-2 inhibitors include established ischemic heart disease, cereberovascular disease, peripheral arterial disease, and treatment of perioperative pain within the setting of coronary artery bypass surgery. bNonselective or selective (low-dose) NSAID without established aspiring interaction if naproxen is ineffective. Data from Jones and coworkers [39]. PPI, proton pump inhibitor.