Key result
Highly selective COX-2 inhibitors (coxibs) increase the risk of cardiovascular toxicity, including myocardial infarction and stroke, compared to non-selective NSAIDs.
Why the study?
Do highly selective COX-2 inhibitors increase cardiovascular toxicity compared to non-selective NSAIDs in patients with pain syndromes?
Do highly selective COX-2 inhibitors increase cardiovascular toxicity compared to non-selective NSAIDs in patients with pain syndromes?
Highly selective COX-2 inhibitors increase the risk of cardiovascular thrombotic events, necessitating careful risk/benefit assessment and preference for moderately selective agents in patients with cardiovascular comorbidities.
Answers are grounded in this paper and cite their sources.
Supports caution with coxibs in CV-risk patients; leaves open optimal NSAID selection pending prospective trials.
Development of highly selective COX-2 inhibitors – coxibs has proved a decreased risk of gastrointestinal toxicity, which was typical for non-selective NSAIDS, according to the evidence-based medicine. But such situation caused an imbalance in the impact on the synthesis of arachidonic acid metabolites: inhibition of COX-2 vasodilatatory prostacyclins and activation of thromboxane synthesis by platelets, which is accompanied by the increase in the frequency of thrombotic complications – myocardial infarctions and strokes. Some meta-analyses have proved this association: the higher is COX-2 inhibitors selectivity – the higher are CV-risks and cardiovascular toxicity of coxibs. Discontinuation or limitation of indications of coxibs, assessment of risk / benefit ratio is recommended in the conditions of comorbidity of CVS pathology, pain syndromes in rheumatology. Drugs of choice are moderately selective COX-2 inhibitors = meloxicam and nimesulide.
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Yakovleva et al. (2018) conducted a review in Pain syndromes in rheumatology and osteoarthritis with cardiovascular comorbidity. Coxibs (highly selective COX-2 inhibitors) vs. Non-selective NSAIDs or placebo was evaluated on Cardiovascular events (myocardial infarction, stroke, and thrombotic complications). Highly selective COX-2 inhibitors (coxibs) increase the risk of cardiovascular toxicity, including myocardial infarction and stroke, compared to non-selective NSAIDs.
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