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Table 2 NSAID selection stratification grid

From: A review of the benefits and risks of nonsteroidal anti-inflammatory drugs in the management of mild-to-moderate osteoarthritis

  No or low NSAID GI risk NSAID GI risk
No CV risk (without aspirin) • Nonselective NSAID (cost consideration) • COX-2-specific inhibitor or nonselective NSAID + proton-pump inhibitora
   • COX-2-specific inhibitor + proton-pump inhibitor for patients with prior GI bleeding
Yes CV risk (with aspirin) • Naproxenb • Proton-pump inhibitor, irrespective of NSAID
  • Addition of proton-pump inhibitor if GI risk of aspirin/NSAID combination warrants gastroprotection • Naproxen if CV risk outweighs GI risk
   • COX-2-specific inhibitor + proton-pump inhibitor for patients with previous GI bleeding
  1. COX-2 = cyclooxygenase-2; CV = cardiovascular; GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug.
  2. aMisoprostol at full dosage (200 μg qid) may be substituted for a proton-pump inhibitor.
  3. bNonselective or selective (low-dose) inhibitor without established aspirin interaction if naproxen is ineffective.
  4. From Scheiman and Fendrick 48