Pericarditis: aspirin and indomethacin brought relief.

Clinical bottom line (level 1b-)

  1. In patients with post-infarction pericarditis treatment with indomethacin or aspirin brought relief.
  2. In patients with post-infarction pericarditis treated with aspirin or indomethacin, an appreciable number experienced side-effects (8%).
Berman et al: American Heart Journal 1981; 101 (6): 750-753
Expires March 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, USA

24 patients (aged mean 60y (range 26 - 76), 71% male) post-myocardial infarction pericarditis (diagnosed on clinical grounds without ECG evidence of further infarction). 25 episodes in 24 patients.

Excluded if
  • onset >30 days after MI


    • Note:
  • No comment on allocation concealment.


    • Control Group: (n = 12, 12 analysed): aspirin 650mg QDS for 24 hr, increased to 975mg QDS if no response
    Experimental Group: (n = 12, 12 analysed): indomethacin 25mg QDS for 24h, increased to 50mg QDS if no response

    100% followed for 2 days
    Outcome notes:
    • gastrointestinal bleeding : (no treatment was required for the GI bleeds)

    The evidence

    aspirin vs indomethacin
    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no resolution of symptoms 2 days 1
    (8.3%)    		 1
    (7.7%)    		 8%
    (-1200% to 94%)    		 0.64%
    (-20.7% to 22.0%)    		 160
    (NNT = 5 to infinity;
    NNH = 5 to infinity)
    gastrointestinal bleeding 2 days 1
    (8.3%)    		 1
    (7.7%)    		 8%
    (-1200% to 94%)    		 0.64%
    (-20.7% to 22.0%)    		 156
    (NNT = 5 to infinity;
    NNH = 5 to infinity)

    Comments

    1. Lack of a placebo arm limits the usefulness of this study.
    2. The study is far to small to show differences in efficacy or safety.

    Citation

    1. Berman J, Haffajee CI, Alpert JS: Therapy for symptomatic pericarditis after myocardial infarction: Retrospective and prospective studies of aspirin, indomethacin, prednisone, and spontaneous resolution. American Heart Journal 1981; 101 (6): 750-753
    Contributor: Bob Phillips and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient post-infarction pericarditis
    Intervention or Exposure treatment with aspirin or indomethacin
    Outcome resolution of symptoms