Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr. Amit Garg


Several case reports suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may be

associated with thrombotic microangiopathy (TMA). We conducted a matched case-control

study with linked administrative healthcare data in Ontario, Canada to assess the relationship

between TMA hospitalization and recent exposure to prescription NSAIDs versus

acetaminophen (where the latter was a referent group with no known association with TMA).

Cases and controls were drawn from a source population of adults who filled a prescription

for NSAIDs or acetaminophen between 1996 and 2015 (restricted to adults with prescription

drug benefits). Cases comprised individuals hospitalized with TMA between 1996 and 2015.

Controls were matched to cases (4:1) on demographic and medical risk factors. Cases (n=38) were less likely to have received a recent prescription for NSAIDs relative to acetaminophen (adjusted odds ratio 0.37, 95% confidence interval 0.16-0.84). Results were similar in two additional analyses with alternative referent groups. Overall, the results of this study do not support a harmful association between NSAID use and TMA.