The vascular effects of COX-2 selective inhibitors

Drugs, such as celecoxib and rofecoxib, which selectively inhibit the COX-2 enzyme, are as efficacious as other non-steroidal antiinflammatory drugs, but reduce the risk of serious gastrointestinal bleeding and ulceration.However, the improved tolerance of the COX-2 selective inhibitors may come at the cost of an increased risk of thrombosis in patients with ischaemic heart disease if they are not also taking aspirin.Like the older non-steroidal anti-inflammatory drugs, the COX-2 selective inhibitors can also increase blood pressure, induce or worsen cardiac failure and impair kidney function to the point of renal failure.In a recent unpublished trial, on the use of rofecoxib to prevent colon cancer, the risk of myocardial infarction and stroke after 18 months of treatment was high enough to prompt the removal of rofecoxib from the market.If another COX-2 selective drug is prescribed for patients at risk of thrombosis it should be used at the lowest effective dose and for short periods wherever possible.Prophylaxis with low-dose aspirin or other anti-thrombotic treatment should be continued.