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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-36611

Steffel, J; Luscher, T F; Ruschitzka, F; Tanner, F C (2006). Cyclooxygenase-2 inhibition and coagulation. Journal of Cardiovascular Pharmacology, 47 Sup:S15-20.

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Selective inhibitors of cyclooxygenase-2 (COX-2) have come under scrutiny because of a possibly increased thrombotic risk observed in retrospective studies and comparatively small cancer trials. Indeed, inhibition of COX-2 may favor a prothrombotic environment by suppressing endothelial prostacyclin synthesis while leaving COX-1-dependent platelet thromboxane (TX) A2 synthesis unopposed. However, in vitro studies have shown that the effect of coxibs on coagulation is dependent on several variables; for example, the coxib celecoxib reduces endothelial tissue factor expression, a key initiator of the coagulation cascade. Furthermore, animal studies are inconclusive as some studies investigating the effect of COX-2 inhibition in atherosclerosis imply a detrimental effect of coxibs, whereas others suggest a beneficial effect on plaque progression and stability. In healthy human subjects and in patients with atherosclerotic vascular diseases, the effect of COX-2 inhibition on coagulation is equally unclear as no prospective, randomized, double-blinded studies sufficiently powered to investigate cardiovascular endpoints have been performed to directly investigate a potentially cardiotoxic effect of coxibs. Here, we review the effect of COX-2 inhibition on the coagulation system; we discuss the molecular mechanisms involved and summarize important clinical trials in which an increased frequency of thrombotic complications coxibs was observed.


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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Animals;Blood Coagulation/*drug effects;Cyclooxygenase 2/*metabolism;Cyclooxygenase Inhibitors/*pharmacology;Endothelial Cells/drug effects/enzymology;Humans;Macrophages/drug effects/enzymology;Models, Animal
Deposited On:25 Feb 2011 13:08
Last Modified:05 Apr 2016 14:17
Publisher:Lippincott Wiliams & Wilkins
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:10.1097/00005344-200605001-00004
PubMed ID:16785824

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