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Table 1 Clinicians' guide to anti-inflammatory therapy

From: The use of proton pump inhibitors in treating and preventing NSAID-induced mucosal damage

Cardiovascular risk No or low gastrointestinal risk Increased gastrointestinal risk
No cardiovascular risk (no aspirin use) Nonselective NSAID (cost consideration) COX-2 selective inhibitor or nonselective NSAID + PPI COX-2 selective inhibitor + PPI for those with prior gastrointestinal bleeding
Cardiovascular risk (aspirin use) Naproxena PPI irrespective of NSAID
  Addition of PPI because gastrointestinal risk of aspirin + NSAID combination typically warrants gastroprotection Naproxen if cardiovascular risk outweighs gastrointestinal risk
   COX-2 selective inhibitor + PPI for those with previous gastrointestinal bleeding
  1. PPI, proton pump inhibitor. Modified from [30]. aNonselective NSAID without established aspirin interaction or (low-dose) cyclooxygenase (COX)-2 selective NSAID if naproxen is ineffective.