Recent studies build a strong case to suggest that there is a clear risk
Clearly, stroke prevention is preferable to the currently available treatments, particularly for haemorrhagic stroke. The burden of stroke is substantial, so all strategies to reduce risk must be considered. The traditional risk factors, especially hypertension, are well recognised, but there is also increasing interest in identifying and modulating novel risks1 and precipitant causes. In this issue of the Journal, an important article by Caughey and colleagues2 adds to the growing literature concerning the risk of stroke related to the use of non-steroidal anti-inflammatory drugs (NSAIDs), particularly those with selective cyclooxygenase (COX)-2 inhibition. If the use of these agents is a clear and substantial risk, then avoiding such medications, particularly in high-risk patients, may be an important preventive strategy. But is the risk clear and substantial, or are other factors involved? Is there a potential for abandoning useful medications and also creating undue anxiety for patients currently using them to treat painful chronic conditions?
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