From the Guidelines
You should avoid taking naproxen if you have a history of coronary artery bypass graft (CABG) surgery, unless specifically approved by your cardiologist, due to the increased risk of cardiovascular events such as heart attack and stroke. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase this risk, particularly in people with existing heart disease, as noted in a scientific statement from the American Heart Association 1. After CABG surgery, this risk may be even more significant. NSAIDs like naproxen can also reduce the effectiveness of certain heart medications, interfere with blood clotting, and potentially increase blood pressure.
The use of NSAIDs, including naproxen, is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, as stated in the warnings and clinical trials section of a study on the use of nonsteroidal antiinflammatory drugs 1. For pain relief, acetaminophen (Tylenol) is usually a safer alternative for patients with heart disease. If you need stronger pain management, consult your cardiologist who might recommend a specific pain management plan that considers your cardiac history.
Some key points to consider when managing pain in patients with a history of CABG include:
- Avoiding NSAIDs like naproxen due to the increased risk of cardiovascular events
- Using acetaminophen as a safer alternative for pain relief
- Consulting a cardiologist for a specific pain management plan that considers the patient's cardiac history
- Never starting or stopping any medication without discussing it with a healthcare provider who understands the complete medical history, as emphasized in guidelines for coronary artery bypass graft surgery 1.
From the FDA Drug Label
Naproxen is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery Naproxen tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery
Naproxen is contraindicated in patients with a history of CABG surgery for the treatment of peri-operative pain.
- Key consideration: Patients with a history of CABG surgery may be at increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
- Clinical decision: Avoid taking Naproxen with a CABG history, especially in the peri-operative period, due to the increased risk of adverse cardiovascular events 2 2.
From the Research
Considerations for Taking Naproxen with CABG History
- The decision to take Naproxen after coronary artery bypass grafting (CABG) should be based on an assessment of individual risk factors 3.
- Naproxen, at a dose of 1000 mg/day, apparently does not increase the risk of vascular events 3.
- However, the use of Naproxen may decrease the cardioprotective effect of low doses of aspirin 3.
- A study found that Naproxen seemed to carry the highest risk for acute myocardial infarction (AMI)/gastrointestinal (GI) bleeding among non-users of aspirin 4.
- In contrast, another study found that Naproxen did not show significant benefit in terms of reduced cardiovascular risk compared to celecoxib or etoricoxib 5.
- The use of secondary prevention medications, such as statins, renin-angiotensin-aldosterone system (RAAS) inhibitors, and platelet inhibitors, is essential after CABG, but the routine use of β-blockers may be questioned 6.
- There is no direct evidence to suggest that Naproxen is contraindicated in patients with a history of CABG, but the potential risks and benefits should be carefully considered 3, 4, 5, 7, 6.
Key Findings
- Naproxen may be considered a safer option for patients with cardiovascular risk factors due to its lower risk of vascular events 3.
- The use of Naproxen should be carefully monitored, especially in patients taking aspirin or other medications that may interact with Naproxen 3, 4.
- Patients with a history of CABG should be closely monitored for cardiovascular risk factors and managed accordingly 6.