Among the commonly prescribed non-selective NSAIDs, which one is associated with the lowest cardiovascular thrombotic risk and may be preferred in patients with elevated cardiovascular risk who still require an NSAID?
- A Naproxen ✓
- B Indomethacin
- C Diclofenac
- D Piroxicam
Correct answer: A. Naproxen
Explanation
Observational data and meta-analyses place naproxen closest to placebo for cardiovascular thrombotic events, an effect attributed partly to its longer-lasting platelet COX-1 inhibition resembling low-dose aspirin behaviour. Diclofenac carries a cardiovascular risk approaching that of some coxibs, and indomethacin and piroxicam also show higher event rates. Naproxen still carries gastrointestinal risk, so gastroprotection is often added, but its relative cardiovascular safety makes it the usual choice in this setting.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
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