Should Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) be avoided in patients with a dilated ascending aorta?

From the Guidelines

NSAIDs should be avoided in patients with a dilated ascending aorta due to their potential to increase blood pressure and stress on the aortic wall. The primary goal in managing aortic diseases is to reduce shear stress on the diseased segment of the aorta by controlling blood pressure and cardiac contractility 1. NSAIDs, including ibuprofen and naproxen, can increase blood pressure and may theoretically exacerbate aortic dilation or increase the risk of complications like dissection or rupture.

Key considerations for patients with a dilated ascending aorta include:

• Controlling blood pressure below 140/90 mm Hg with lifestyle changes and antihypertensive drugs if necessary 1
• Avoiding competitive sports to prevent blood pressure spikes 1
• Considering alternative pain management options, such as acetaminophen, which is generally safer for patients with aortic diseases
• Consulting a cardiologist or vascular specialist before using NSAIDs, as they may recommend specific alternatives or carefully monitored NSAID use based on individual risk factors and overall cardiovascular health.

The use of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers may be beneficial in reducing the progression of aortic dilation or the occurrence of complications in certain patients, such as those with Marfan syndrome 1. However, the primary concern with NSAIDs in patients with a dilated ascending aorta is their potential to increase blood pressure and stress on the aortic wall, making avoidance of these medications a prudent recommendation.

From the Research

NSAIS and Dilated Ascending Aorta

• There is no direct evidence in the provided studies regarding the use of NSAIS (Non-Steroidal Anti-Inflammatory Drugs) in patients with a dilated ascending aorta.
• However, the studies focus on the management and treatment of dilated ascending aorta, which may imply that any medication or treatment should be carefully considered to avoid exacerbating the condition.

Management of Dilated Ascending Aorta

• The study 2 discusses the surgical treatment of the dilated ascending aorta, highlighting the importance of considering the patient's age, aortic valve function, and aortic wall pathology when deciding on elective surgery.
• Another study 3 compares the outcomes of different management strategies for dilated ascending aorta during aortic valve replacement, suggesting that valve replacement alone may be sufficient in some cases.
• The study 4 investigates the prognostic role of ascending aorta dilatation in patients with arterial hypertension, finding that aortic dilatation is associated with an increased risk of cardiovascular events.
• The study 5 examines the outcomes of repairing the dilated ascending aorta at the time of bicuspid aortic valve replacement, concluding that concurrent repair may not substantially improve morbidity and mortality outcomes.

Indications for Surgery

• The study 6 discusses the diagnosis, clinical presentation, and indication for surgery in patients with ascending aortic aneurysm, highlighting the importance of a multidisciplinary approach and multimodal imaging in therapeutic decisions and monitoring.
• The study 2 provides guidelines for intervening in degenerative dilatation of the ascending aorta, considering factors such as the patient's age, aortic valve function, and aortic wall pathology.