Do Cyclooxygenase-2 Inhibitors Raise Coronary Event Risk?

Cyclooxygenase-2 (Cox-2) inhibitors are widely used in the elderly population. There have been contradictory studies on the effect of this class of agents on coronary atherothrombotic events. Cox-2 specific inhibitors (rofekoksib, celekoksib, etc.) decrease synthesis of prostaglandin-I2 and therefore predisposes to a prothrombotic state. They seem to have an adverse effect on myocardial preconditioning, as well . These issues have been the main concern about the use of this class of agents. In addition, Cox-2 enzyme has an important role in the inflammatory process which is a triggering factor on atherothrombosis. By contrast, some preliminary reports indicated that antiinflammatory properties of Cox-2 inhibitors might be useful during an acute coronary syndrome. These pros and cons on the use of Cox-2 inhibitors should be clarified with a large randomized prospective study. (Türk Kardiyol Dern Arş 2004; 32: 371-375)