Cardiovascular risks of COX-2 inhibitors

Abstract

The cardioprotective properties of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are well established, but the effects of selective cyclooxygenase 2 (COX-2) inhibitors on the cardiovascular system are not fully known. Because COX-1 produces the prothrombotic thromboxane A2 whereas COX-2 is responsible for the synthesis of prostaglandin I2 (PGI2), a vasodilator and antiplatelet aggregation factor, the use of selective COX-2 inhibitors might tip the clotting cascade towards a prothrombotic state. A meta-analysis of several clinical trials found evidence that chronic use of COX-2 inhibitors might be associated with an increased incidence of thrombotic events. Given the widespread use of COX-2 inhibitors, the authors propose that clinical studies should evaluate this potential risk and urge caution with the use of COX-2 inhibitors in patients at risk of cardiovascular morbidity. [Mukherjee, D. et al. (2001) Am. J. Med. Assoc. 286, 954–959]