The use of NSAIDs is associated with an increased risk of Cardiovascular events. Which of the following NSAIDs would be the least appropriate for a patient with a past history of Stroke?

• A. Ibuprofen
• B. Diclofenac 150 mg daily
• C. Naproxen
• D. Celecoxib

Answer: (B)

The main idea is that cardiovascular risk differs between NSAIDs, and in someone with a history of stroke you want to avoid those with higher pro-thrombotic potential. Diclofenac, especially at a higher dose like 150 mg daily, has a well-established association with arterial thrombotic events, including stroke. This makes it the least appropriate choice for a patient who has already had a stroke. Naproxen is generally considered to carry the lowest cardiovascular risk among common NSAIDs, and ibuprofen and celecoxib have CV risks that are not as pronounced as diclofenac at typical doses. So, diclofenac stands out as the option to avoid in someone with a prior stroke.