Cardiovascular Thromboembolic Adverse Effects Associated with Cyclooxygenase-2 Selective Inhibitors and Nonselective Antiinflammatory Drugs

Joshi, Girish P.; Gertler, Ralph; Fricker, Ruth

doi:10.1213/01.ane.0000286229.05723.50

Cited by 54 publications

(18 citation statements)

References 57 publications

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“…After this report, several analyses or meta-analyses (for review see (89,90)) provided evidence for or against an increased CV risk during selective COX-2 inhibitor therapy. The results of three different studies (10,11,91) documenting an increase in AMI risk after rofecoxib, celecoxib, and parecoxib/valdecoxib confirmed that CV adverse events with these drugs is a class-rather than a molecule-dependent effect, and that the risks may be dose-related.…”

Section: Myth 6: Non-selective Nsaids Are Not Associated With Increasmentioning

confidence: 99%

Myths and facts in the use of anti-inflammatory drugs

Hunt

Lanas²,

Stichtenoth

et al. 2009

Annals of Medicine

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Pain relief must be considered a human right, and patients with osteoarthritis pain should be treated appropriately with analgesic or/and anti-inflammatory drugs. The risk of gastrointestinal (GI) complications with traditional non-steroidal anti-inflammatory drugs (t-NSAIDs) is present from the first dose (with both short-term and long-term use), and strategies to prevent GI complications should be considered regardless of the duration of therapy. Compared with t-NSAIDs, coxib use is associated with a small but significant reduction of dyspepsia. While protecting the stomach, proton pump inhibitors do not prevent NSAID-induced intestinal damage. To this end, coxib therapy could be the preferred option, although further randomized studies are needed. A substantial number of patients who need NSAIDs are also taking low-dose aspirin for cardiovascular prophylaxis. From a GI perspective, the combination of aspirin plus a coxib provides a preferred option compared with aspirin plus a t-NSAID, for patients at high GI risk. As the incidence of renovascular adverse effects with t-NSAIDs and coxibs is similar, blood pressure should be monitored and managed appropriately in patients taking these drugs, although they should be avoided in those with severe congestive heart failure. Due to increased cardiovascular risk, which is dependent on the dose, duration of therapy, and base-line cardiovascular risk, both t-NSAIDs and coxibs should be used with caution in patients with underlying prothrombotic states and/or concomitant cardiovascular risk factors.

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Section: Myth 6: Non-selective Nsaids Are Not Associated With Increasmentioning

confidence: 99%

Myths and facts in the use of anti-inflammatory drugs

Hunt

Lanas²,

Stichtenoth

et al. 2009

Annals of Medicine

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show abstract

“…Nevertheless, this study also shows a significant reduction of NSAID consumption which is an index of achieving clinical benefit, but it may also imply broader considerations about cost/benefit of such treatments. In this study patients who had received VS treatment benefited from a 63% reduction in NSAID intake at 12 months; it is known that side effects are directly correlated to the amount of NSAID intake (26)(27)(28). The limitation of the present study is the inability to exclude the placebo effect of this injection as there is no comparative arm involved.…”

Section: Fig 2 Pain Vas and Nsaid Consumption Mean Scores Obtained mentioning

confidence: 89%

Efficacy and Safety Profile of Intra-Articular Administration of Jointex® in Patients Suffering from Symptomatic Hip Osteoarthritis: An Open, Prospective Study with a 12-Month Follow-up

et al. 2011

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Hip osteoarthritis represents a statistically relevant problem in clinical practice; previous reports showed different efficacy and safety profiles for intra-articular use of hyaluronic acid in hip osteoarthritis-affected patients, and in this sense, to add evidence to this topic, data regarding safety and efficacy of ultrasound-guided viscosupplementation are reported in order to establish whether such a therapeutic tool may represent a valid option. This study investigates the safety and efficacy profiles of ultrasound-guided intra-articular injections of Jointex® in hip osteoarthritis affected patients. This is a prospective multicentric study carried out in public hospitals. Adult outpatients suffering from symptomatic hip OA (Kellgren and Lawrence Grade 2, 3 or 4) were injected with one syringe of 4 ml (2 vials) of Jolntex" under ultrasound guidance, repeated after six months; when clinically necessary an adjunctive injection was performed. Patients' characteristics, such as gender, age, weight, height and BMI, smoking habit, unilateral or bilateral hip OA, radiological grade for hip OA following KellgrenLawrence grading and duration of disease, were evaluated. Patients were assessed at baseline and at every control visit and injection time for Lequesne index as primary endpoint, pain (evaluated by VAS) and NSAID consumption (number of days patients assumed NSAID in the last month) both as secondary endpoint. A total of 180 patients entered the study, all of whom received at least one IA US-guided injection of .lointex" into the hip joint. A total of 36 drop outs were registered, and both distribution and causes of drop out were recorded. A total of 389 injections were carried out, as 18 patients were affected by bilateral hip OA and 7 patients affected by monolateral hip OA required one more injection for symptomatic relief in respect to other patients. Scores obtained for primary as well as secondary study endpoints reached statistical significance when compared with scores obtained at baseline visit. Lequesne index mean scores obtained at each control visit, when compared with baseline mean value, were significantly different (p

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“…For individual patients, their cardiovascular risk factors and the risks of alternative drugs or analgesic techniques need to be considered. The cardiovascular risk between agents varies, for example the NSAID naproxen has a lower cardiovascular risk profile than diclofenac [86].…”

Section: Cox-2 Inhibitorsmentioning

confidence: 99%