Many patients with chronic pain use the so-called non-steroidal, anti-inflammatory drugs (NSAIDs), including the COX-2 selective Celebrex. But many patients, on the other hand, have a fear of Celebrex because of the perceived risk of heart attack. Data presented at this summer’s congress sponsored by the European League Against Rheumatism (EULAR) show that taking aspirin may completely reverse the increased risk of thrombosis in patients taking Celebrex. In fact, aspirin use may also reduce the cardiovascular risk seen in the older NSAIDs.
Unfortunately, there is also evidence that the use of aspirin combined with either Celebrex or the older NSAIDs can increase the risk of gastrointestinal bleeding.
Dr. Gurkirpal Singh gathered his data from records kept on California Medicare patients with rheumatoid arthritis or osteoarthritis. He found that the risk of heart attack was increased by 31 percent in patients treated with Vioxx, and by 12 percent in patients treated with Celebrex.
But he also found the risk of heart attack increased by 65 percent in patients on indomethacin, 52 percent in patients on Mobic, and by 47 percent in patients on sulindac.
The use of aspirin reversed the increased risk of heart attack in patients taking Vioxx, Celebrex, Mobic, and sulindac. However, patients on indomethacin and aspirin still had a 20 percent increased risk of heart attack.
It would appear that the 24 hour of inhibition of clotting that one aspirin provides protects from heart attack. But doctors and patients must remember the risk of bleeding from the gastrointestinal tract with chronic aspirin use combined with NSAID use.
At this time, the U.S. Food and Drug Administration has warnings on the increased cardiovascular risk with the use of NSAIDs, Cox-2 selective and otherwise.
More studies need to be done to determine whether medications to protect against gastrointestinal bleeding can adequately protect patients with chronic pain on both aspirin and drugs such as Celebrex or sulindac or indomethacin, etc.
Published On: September 15, 2006