{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:13:28Z","timestamp":1791976408242,"version":"4.4.0"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,11,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Pain is a major issue in our aging society. Dipyrone (metamizole) is one of the most frequently used analgesics. Additionally, it has been shown to impair pharmacodynamic response to aspirin as measured by platelet function tests. However, it is not known how this laboratory effect translates to clinical outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a nationwide analysis of a health insurance database in Germany comprising 9.2\u00a0million patients. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36\u00a0months. Inverse probability of treatment weighting analysis was conducted to investigate the rate of mortality, myocardial infarction, and stroke\/transient ischemic attack between patients on aspirin\u2010dipyrone co\u2010medication compared with aspirin\u2010alone medication. Permanent aspirin\u2010alone medication was given to 26,200 patients, and 5946 patients received aspirin\u2013dipyrone co\u2010medication. In the inverse probability of treatment weighted sample, excess mortality in aspirin\u2013dipyrone co\u2010medicated patients was observed (15.6% in aspirin\u2010only group versus 24.4% in the co\u2010medicated group, hazard ratio [HR], 1.66 [95% CI, 1.56\u20131.76],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). Myocardial infarction and stroke\/transient ischemic attack were increased as well (myocardial infarction: 1370 [5.2%] versus 355 [5.9%] in aspirin\u2010only and co\u2010medicated groups, respectively; HR, 1.18 [95% CI, 1.05\u20131.32];\n              <jats:italic>P<\/jats:italic>\n              =0.0066, relative risk [RR], 1.14; number needed to harm, 140. Stroke\/transient ischemic attack, 1901 [7.3%] versus 506 [8.5%] in aspirin\u2010only and co\u2010medicated groups, respectively; HR, 1.22 [95% CI, 1.11\u20131.35];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001, RR, 1.17, number needed to harm, 82).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In this observational, nationwide analysis, aspirin and dipyrone co\u2010medication was associated with excess mortality. This was in part driven by ischemic events (myocardial infarction and stroke), which occurred more frequently in co\u2010medicated patients as well. Hence, dipyrone should be used with caution in aspirin\u2010treated patients for secondary prevention.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.022299","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T09:05:59Z","timestamp":1635843959000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Excess Mortality in Aspirin and Dipyrone (Metamizole) Co\u2010Medicated Patients With Cardiovascular Disease: A Nationwide Study"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5891-9672","authenticated-orcid":false,"given":"Amin","family":"Polzin","sequence":"first","affiliation":[{"name":"Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute D\u00fcsseldorf (CARID) Heinrich Heine University Medical Center D\u00fcsseldorf D\u00fcsseldorf 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Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute D\u00fcsseldorf (CARID) Heinrich Heine University Medical Center D\u00fcsseldorf D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Metzen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute D\u00fcsseldorf (CARID) Heinrich Heine University Medical Center D\u00fcsseldorf D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Mourikis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute D\u00fcsseldorf (CARID) Heinrich Heine University Medical Center D\u00fcsseldorf D\u00fcsseldorf 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