Myocardial infarction diclofenac

In VIGOR, rofecoxib 50 mg/day was associated with a higher rate of non-fatal myocardial infarction (0.4%) than the non-selective COX-2 inhibitor naproxen 500 mg bd (0.1%) (RR = 0.2 Cl = 0.1, 0.7) (33). In CLASS there was no difference in the rates of myocardial infarction in patients taking celecoxib (0.5%) and those taking ibuprofen or diclofenac (0.4%). However, the protocols of the two studies differed substantially with respect to the use of aspirin. In VIGOR, the patients were not allowed to take aspirin or any other antiplatelet drug, while in... 

Meloxicam demonstrates some COX-2 selectivity, but a clinical advantage or hazjard has yet to be established. There is significantly less gastric injury compared to piroxicam (20 mg/day) in subjects treated with 7.5 mg/day of meloxicam, but the advantage is lost with 15 mg/day. Like diclofenac, meloxicam does not offer a desirable cdterrmtive to prescribing celecoxib to patients at increased risk of myocardial infarction or stroke. 

FP has a history of cardiovascular disease, having survived a myocardial infarction that occurred in his mid-50s and, more recently, a stroke. Currently, he is on extended-release diltiazem (Cardiazem, 420 mg q.i.d.) and betaxolol HCI (Kerlone, 10 mg q.i.d.) for chronic stable angina coupled with hypertension. He also takes one baby aspirin each day. FP is troubled by rheumatoid arthritis, for which he takes diclofenac (Voltaren, 50 mg t.i.d.), and he has a documented allergy to sulfonamides. 

Serious and potentially fatal cardiovascular (CV) thrombotic events, myocardial infarction, and stroke can occur with NSAID treatment. Diclofenac should be used with caution in patients with known CV disease or risk factors for CV disease. 

In a case-control study using drug-dispensing and hospitalization data from more than 2 million residents in The Netherlands, subjects with a first hospitalization for acute myocardial infarction, cardiovascular and gastrointestinal events were identified [14 J. Use of coxibs and non-selective NSAIDs was classified into remote, recent, and current use. Compared with remote use, the risk of acute myocardial infarction was increased in current users of all coxibs (adjusted OR = 1.73 95% Cl = 1.37, 2.19) and all non-selective NSAIDs (adjusted OR = 1.41 95% Cl = 1.23, 1.61). Analysis by separate agents showed that the risk of acute myocardial infarction was increased with celecoxib (OR = 2.53 95% Cl = 1.53, 4.18), rofecoxib (OR = 1.60 95% Cl = 1.22, 2.10), ibuprofen (OR = 1.56 95% Cl — 1.19, 2.05), and diclofenac (OR = 1.51 95% Cl = 1.22, 1.87), but not with naproxen (OR = 1.21 95% Cl = 0.87,1.68). 

Cardiovascular Kounis syndrome (acute myocardial infarction occurring during the course of an allergic reaction) has been attributed to diclofenac [35 ]. 

---