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 |