NSAIDs Following Heart Bypass

Hello and thanks for your question! I am more than happy to go over this topic.

As a general rule of thumb, NSAIDs (non-steroidal anti-inflammatory drugs) should not be used in those with pre-existing cardiovascular (i.e. heart) conditions without first consulting with your doctor.

Having a history of coronary bypass would certainly categorize you as someone with a pre-existing heart condition, and would also put you in a high-risk category for further cardiovascular complications, so NSAIDs are not the pain reliever of choice for you.

NSAIDs And Cardiovascular Risk

Very simply put, the use of NSAIDs is associated with an increased risk of negative cardiovascular outcomes (which includes things like heart attacks).

This warning includes all NSAIDs, including newer generation 'selective' NSAIDs, such as Celebrex (celecoxib). It also includes ibuprofen, which you mentioned.

While not a complete list, below are some commonly used NSAIDs:

• Celecoxib
• Ibuprofen
• Naproxen
• Nabumetone
• Meloxicam
• Diflunisal
• Sulindac
• Etodolac
• Indomethacin
• Oxaprozin

The use of NSAIDs should also be used cautiously in those with high blood pressure, as they can raise it.

There are a lot of factors to consider when it comes to how much NSAIDs increase cardiovascular risk, including person-specific factors, such as:

• History of cardiovascular disease
• Age
• Gender
• Concurrent disease states (e.g. hypertension, hyperlipidemia, diabetes)
• Lifestyle (e.g. smoking)
  

There are also drug-related factors.

Some drugs may be riskier than others, and factors such as the dose you take, and how often, also are important factors in just how dangerous an NSAID may be in certain populations.

It is important to note that NSAIDs increase cardiovascular risk in all individuals, not just those with pre-existing cardiovascular conditions

There are hundreds of studies on the matter, and while some are more definitive than others, below are the conclusions of several large-scale, well-regarded ones:

Current use of all NSAIDs is associated with a modest risk of first time MI [myocardial infarction (i.e. heart attack)]

Use of non-aspirin NSAIDs was associated with an increased risk of atrial fibrillation or flutter. Compared with non-users, the association was strongest for new users, with a 40-70% increase in relative risk (lowest for non-selective NSAIDs and highest for COX 2 inhibitors).

Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.

Current evidence indicates that selective COX-2 inhibitors have important adverse cardiovascular effects that include increased risk for myocardial infarction, stroke, heart failure, and hypertension. The risk for these adverse effects is likely greatest in patients with a prior history of or at high risk for cardiovascular disease

If NSAIDs are prescribed by your doctor and you have risk factors for cardiovascular disease or have a pre-existing cardiovascular condition, they should be used at the lowest effective dose for the shortest time possible.

Alternative Options

If NSAIDs aren't an option for you, you have some potential alternatives, including:

• Topical NSAIDs (e.g. Voltaren)
• Acetaminophen
• Capsaicin
• IcyHot and other related products

Be sure to talk to your doctor about what is safe for your particular medical situation.

Final Words

You mentioned in your question the drug Volatrol, which isn't available as that brand name in the United States but contains the drug diclofenac, which is available in the United States under several other brand names (e.g. Voltaren, Cataflam, Zipsor, etc...).

As diclofenac is an NSAID, it carries the same cardiovascular risk.

Thank you again for your question and please feel free to reach out again in the future.