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DrDLove, MD
Category: Cardiology
Satisfied Customers: 17354
Experience:  Cardiology Expert
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I have been told not to take the pain reliever "Diclofenac"

Customer Question

I have been told not to take the pain reliever "Diclofenac" if I should ever have any blood vessel blockages to the heart or brain or any operation to clear or bypass any such
blockage(s). Why is this and what would be the risks if administered unknowingly?
Submitted: 5 months ago.
Category: Cardiology
Expert:  dr abid replied 5 months ago.
Hi there ...Thank you for the question ...Diclofenac will not effect you by any mean if you have ever blood vessel blockage , or any surgery in past .You can take it safely .Regards ***** ***** my answer as good service .Thanks .
Customer: replied 5 months ago.
My request was for a "No Rush" and "In Depth" response regarding the safe usage of the pain reliever "Diclofenac". The information I provided you is based on studies performed by research groups that specialize in drug safety issues and are available to the general public. Your response contradicts this information. How could you possibly reach this conclusion and respond back to me in less than 5 minutes? I clearly stated "No Rush" and "In Depth" and paid the requested fee.
Would you like to re-evaluate your response or would you prefer I provide a rating based on your current response?
Expert:  DrDLove replied 5 months ago.
The other expert has opted out. The issue with diclofenac and heart disease is because of the effect on platelets, a cell fragment int he blood that can clump together to form small clots. All of the non-steroidal anti-inflammatory drugs, NSAIDs, work by inhibiting an enzyme that is involved in the formation of prostaglandins, and prostaglandin is a key modulator of musculoskeletal inflammation. Prostaglandins are also important for the functioning of platelets, but it is more complicated. One type of prostaglandin is made by the platelets and supports the formation of blood clots, but another type of prostaglandin is made by the blood vessels and inhibits the formation of blood clots. Aspirin in low doses will help to prevent blood clots in the coronary or cerebral arteries preventing heart attacks and strokes because it will preferentially inhibit the formation of prostaglandins in the platelets. This works only with aspirin because it will permanently inhibit the enzyme and platelets are unable to make more of the enzyme because they are cell fragments. Aspirin will also inhibit the enzyme in the blood vessels, but when the dose is small, the aspirin will leave the body relatively quickly and the blood vessels that are made from complete cells will simply make more of the enzyme. If aspirin is taken at higher doses, it will not prevent heart attacks and stroke because it will inhibit both prostaglandins. The NSAIDs, which do not permanently inhibit the platelet enzymes and are longer acting, will affect both types of prostaglandins and this results in the small increased risk of heart attacks and strokes that has led to the recommendation to avoid NSAIDs. With further study, we have also found that the risk of side effects will vary with the various NSAIDs. While all NSAIDs entail some risk, the NSAID with the lower cardiovascular risk is naproxen. The diclofenac has a 40-50% higher risk than naproxen. Unfortunately, it is also true that there is a trade-off for the naproxen, because it appears to have a higher risk for stomach side effects. However, in someone with known cardiovascular disease or is at high risk of cardiovascular disease, this is a larger concern than the stomach side effects. We would prefer to avoid any NSAID, but if a situation arises in which treatment is being considered, it is appropriate to use the shortest course of naproxen that is able to get control of the situation. If I can provide any additional information, please let me know.
Customer: replied 5 months ago.
I am aware of the small increased risk of heart attacks and strokes that you pointed out in your response; however, my request dated 18 May 2016, and referred to in my response to Dr. Abid, specifically asks about the risk of using Diclofenac under certain circumstances. Please refer to the aforementioned request and advise.
Expert:  DrDLove replied 5 months ago.
The circumstances that you mentioned in your original question was "if I should ever have any blood vessel blockages to the heart or brain or any operation to clear or bypass any such blockage(s)." In these circumstances, the risk is the effect on platelets that I noted in my answer and the risk that it creates for heart attacks and strokes.

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