The risks of cardiovascular and cerebrovascular toxicity associated with non-steroidal antiinflammatory drugs (NSAIDs)¹² have prompted reappraisal of the use of these drugs and led to the inclusion of “black box” warnings in related prescribing information in the United States.3 The European Medicines Agency may also extend its warnings, given that the Medicines and Healthcare Products Regulatory Agency is considering unpublished data from a new clinical trial4 along with all other evidence and is seeking expert advice this month from the Commission on Human Medicines (MHRA, personal communication, 2006).

Clinicians now avoid the use of NSAIDs in patients with established atheromatous disease. In this week's BMJ, however, Fransen and colleagues remind us that this class of drugs has many potential uses including inhibition of ectopic bone formation after joint replacement and postoperative pain relief.5 The authors report a randomised placebo controlled trial of a modest two week dose of postoperative ibuprofen (1200 mg a day) on …