Cardiac toxicity of coxibs: mechanisms of development and their prevention

  • O O Yakovleva National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • A O Zhamba National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • I O Doroshkevych National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • T K Vitruk National Pirogov Memorial Medical University, Vinnytsia, Ukraine
Keywords: NSAIDs, selectivity, coxibs, cardiovascular toxicity, evidence-based medicine

Abstract

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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Published
2018-11-23
How to Cite
1.
Yakovleva OO, Zhamba AO, Doroshkevych IO, Vitruk TK. Cardiac toxicity of coxibs: mechanisms of development and their prevention. PMJUA [Internet]. 23Nov.2018 [cited 15Dec.2018];3(3):27-2. Available from: https://www.painmedicine.org.ua/index.php/pnmdcn/article/view/154