Treatment of Acute Pericarditis When Aspirin and NSAIDs Are Contraindicated or Not Tolerated
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are central to standard pericarditis management. When these agents are contraindicated or the patient cannot tolerate them, a distinct therapeutic approach is required.
Clinical Scenario
This protocol applies to patients with acute pericarditis who have a contraindication to aspirin and NSAIDs, or who are intolerant to these agents. Additional considerations apply in the setting of renal impairment.
Treatment Approach
Management involves restriction of physical activity combined with a corticosteroid-based regimen.
Treatment Goal
Clinical remission: full regression of pericarditis symptoms (chest pain) and normalization of C-reactive protein.
References
DOI: 10.1093/eurheartj/ehaf192
- When aspirin and NSAIDs are contraindicated, or for specific indications, corticosteroids should be considered at low to moderate doses plus colchicine.
- For those with moderate to severe renal impairment, dose adjustment or use of corticosteroids is recommended.
- An important non-pharmacological concept is the restriction of physical activity beyond sedentary activities until symptom resolution and clinical remission with normalization of inflammatory markers.
- Low- to medium-dose corticosteroids should be considered for patients with pericarditis only in cases of contraindication/failure of aspirin/NSAIDs and colchicine, or when there is a specific indication to control symptoms and reduce recurrences.
- Clinical remission is defined as full regression of symptoms, as well as normalization of laboratory results (e.g. C-reactive protein, troponin levels) and investigations (ECG, evidence of PEff, CMR evidence of active inflammation).
View source ↗