Table 1

Clinicians' guide to anti-inflammatory therapy

Cardiovascular risk

No or low gastrointestinal risk

Increased gastrointestinal risk

No cardiovascular risk (no aspirin use)

Nonselective NSAID (cost consideration)

COX-2 selective inhibitor or nonselective NSAID + PPI COX-2 selective inhibitor + PPI for those with prior gastrointestinal bleeding

Cardiovascular risk (aspirin use)


PPI irrespective of NSAID

Addition of PPI because gastrointestinal risk of aspirin + NSAID combination typically warrants gastroprotection

Naproxen if cardiovascular risk outweighs gastrointestinal risk

COX-2 selective inhibitor + PPI for those with previous gastrointestinal bleeding

PPI, proton pump inhibitor. Modified from [30]. aNonselective NSAID without established aspirin interaction or (low-dose) cyclooxygenase (COX)-2 selective NSAID if naproxen is ineffective.

Scheiman Arthritis Research & Therapy 2013 15(Suppl 3):S5   doi:10.1186/ar4177