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Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascularCVthrombotic eventsincluding myocardial infarctionMIand strokewhich can be fatalBased on available datait is unclear that the risk for CV thrombotic events is similar for all NSAIDsThe relative increase in serious CV thrombotic events over baseline conferred by NSAID use appears to be similar in those with and without known CV disease or risk factors for CV diseaseHoweverpatients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic eventsdue to their increased baseline rateSome observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatmentThe increase in CV thrombotic risk has been observed most consistently at higher doses.
To minimize the potential risk for an adverse CV event in NSAID-treated patientsuse the lowest effective dose for the shortest duration possiblePhysicians and patients should remain alert for the development of such eventsthroughout the entire treatment courseeven in the absence of previous CV symptomsPatients should be informed about the symptoms of serious CV events and the steps to take if they occur.
When piroxicam was administered with aspirinits protein binding was reducedalthough the clearance of free FELDENE was not alteredPlasma levels of piroxicam were decreased to approximately 80of their normal values when FELDENE was administered20 mg/dayin conjunction with aspirin3900 mg/dayThe clinical significance of this interaction is not knownsee DRUG INTERACTIONS
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