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Relative thromboembolic risks associated with COX-2 inhibitors
1Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA. schrisjones@yahoo.com
The Annals of Pharmacotherapy
|June 16, 2005
Summary
Cardiovascular risk varies among cyclooxygenase-2 (COX-2) inhibitors. While some COX-2 inhibitors show associations with adverse events, celecoxib appears safest when used appropriately for specific patient groups.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Drug Safety
Background:
- Cyclooxygenase-2 (COX-2) inhibitors are widely used for pain and inflammation.
- Concerns exist regarding their cardiovascular safety profile.
- The incidence of thromboembolic events may differ across the COX-2 inhibitor drug class.
Purpose of the Study:
- To review clinical literature on COX-2 inhibitors.
- To determine if increased thromboembolic events are a class-wide effect.
- To compare the cardiovascular safety of different COX-2 inhibitors.
Main Methods:
- MEDLINE search (1996-2005) for English-language articles.
- Inclusion of randomized controlled trials, case-control, and cohort studies.
- Extraction of cardiovascular safety data from 17 reviewed studies.
Main Results:
- Thromboembolic risk is multifactorial, influenced by drug binding affinity, dose, duration, and patient profile.
- Evidence links rofecoxib, valdecoxib, and celecoxib to cardiovascular adverse events.
- Cardiovascular effects of lumiracoxib and etoricoxib remain uncertain due to limited data.
Conclusions:
- Each COX-2 inhibitor possesses a distinct cardiovascular risk profile.
- Celecoxib is considered the safest COX-2 inhibitor when used appropriately.
- Optimal use involves the lowest effective dose, shortest duration, and suitable patient selection.