Table 5.

Proposed indications for the use of selective COX2 and non-selective NSAIDs according to GI and CV risk (Chan 2006)

CV risk	GI riska
	Low	Moderate	High
Low	NSAID	NSAID + PPI/misoprostol or COX2 inhibitor	COX2 inhibitor + PPI
Highb	NSAIDc + PPI or misoprostol	NSAIDc + PPI or misoprostol	Avoid NSAIDs or COX2 inhibitordd

^aGastrointestinal risk is arbitrarily defi ned as low (no risk factors), moderate (presence one or two risk factors), or high (more than two risk factors, previous ulcer complications, or concomitant use of corticosteroids or anticoagulants). All patients with a history of ulcers who require NSAIDs should be tested for H. pylori and if infection is present, eradication therapy should be given.

^bHigh cardiovascular risk is arbitrarily defi ned as the requirement for low-dose aspirin for primary cardiovascular event prevention (calculated 10-year cardiovascular risk >10%) or secondary prevention of serious cardiovascular events.

^ccNaproxen is the preferred NSAID in patients with a high cardiovascular risk.

^dIbuprofen should be avoided with aspirin (Farkouh et al 2007).

Abbreviations: PPI, proton pump inhibitors.