On an orthopaedic ward, a patient with osteoarthritis requires an NSAID but cannot use a proton pump inhibitor (PPI) and takes dabigatran. Which NSAID is most appropriate?

On an orthopaedic ward, a patient with osteoarthritis requires an NSAID but cannot use a proton pump inhibitor (PPI) and takes dabigatran. Which NSAID is most appropriate?

• A. Ibuprofen
• B. Celecoxib
• C. Naproxen
• D. Diclofenac

Answer: (B)

The main issue is balancing GI safety with anticoagulation. Dabigatran raises the risk of GI bleeding, and not using a proton pump inhibitor removes a protective measure against NSAID‑induced GI injury. COX‑2 selective NSAIDs, like celecoxib, have less impact on the gastric mucosa because they spare COX‑1, which helps protect the stomach. This translates to a lower risk of GI bleeding compared with nonselective NSAIDs that inhibit both COX‑1 and COX‑2 (such as ibuprofen, naproxen, and diclofenac). Although COX‑2 inhibitors carry some cardiovascular concerns, in a patient who cannot take a PPI and is on dabigatran, celecoxib offers the best GI safety profile among NSAIDs, making it the most appropriate choice.

The main issue is balancing GI safety with anticoagulation. Dabigatran raises the risk of GI bleeding, and not using a proton pump inhibitor removes a protective measure against NSAID‑induced GI injury. COX‑2 selective NSAIDs, like celecoxib, have less impact on the gastric mucosa because they spare COX‑1, which helps protect the stomach. This translates to a lower risk of GI bleeding compared with nonselective NSAIDs that inhibit both COX‑1 and COX‑2 (such as ibuprofen, naproxen, and diclofenac). Although COX‑2 inhibitors carry some cardiovascular concerns, in a patient who cannot take a PPI and is on dabigatran, celecoxib offers the best GI safety profile among NSAIDs, making it the most appropriate choice.