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Potentially Fatal GI Bleeding Associated With Use of Cox-2 Drugs and Warfarin

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GI Bleeding Associated With Use of Cox-2 Drugs

Potentially Fatal GI Bleeding Associated With Use of Cox-2 Drugs and Warfarin

February 09, 2005

By: Jean Johnson for Veins1

Aging populations often have to treat more than one ailment at a time – arthritis and poor circulation being high on the list.

Warfarin or Coumadin, is the drug of choice for controlling coagulation factors in the blood and thus preventing clots that cause strokes and heart attacks. For controlling the pain and inflammation from arthritis, though, there is less agreement since even over the counter medicines like ibuprofen, or the nonsteriodal anti-inflammatory drugs, can cause stomach upset and bleeding in the gastrointestinal tract. That’s why the Cox-2 drugs like Vioxx and Celebrex became popular – they were perceived as safer than things like Advil.

The news for Cox-2 drugs has not been good though. First came reports that the drugs increased risk for heart attack, and now a Canadian study has shown that in patients on warfarin, Cox-2 drugs are contraindicated because they double the risk of stomach bleeding.
According to Muhammad Mamdani, expert in pharmacology and health research and a senior author of the Toronto study at the Institute of Clinical Evaluative Sciences, “the condition can be dangerous: About one in 10 patients with a serious stomach bleed die before making it to the hospital for life-saving surgery.”

Researchers investigated almost 99,000 patients 66 years or older who had taken warfarin for at least one year. Of those more than 350 were hospitalized for GI bleeding, and that population was more likely to have taken Celebrex or Vioxx in addition to Coumadin.
Mamdani said the problem is that many physicians might be under the perception that the Cox-2 drugs are so safe that they can be more lax in prescribing them.

At least one Canadian physician feels vindicated by the results of the study. Clinical pharmacologist and internist at the University of British Columbia, Dr. Jim Wright, said that he’s long observed the lack of evidence confirming that the benefits of the Cox-2 drugs outweigh the side effects. In his view, the safer alternative for controlling arthritis pain and inflammation are the over-the-counter ibuprofen drugs. Even with ibuprofen, though, Mamdani notes the same rates of GI bleeding as with the Cox-2 drugs.

In sum, Mamdani suggests treating arthritis with exercise or external rub-on remedies and forgoing both Vioxx and Celebrex as well as the ibuprofens with patients taking blood thinning drugs. So, the Cox-2 drugs that were initially perceived as the answer to GI bleeding problems in patients with arthritis have lost their luster. That along with adverse affects on the heart, puts the class of drugs on the back burner for the foreseeable future. A step back for the manufacturers perhaps, but one that will strengthen state-of-the-art pharmacology research generally, and reassure the medical profession, not to mention those it serves, that sufficient monitoring is in place to catch potential errors.

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