Treatment with high-dose COX-2 inhibitors or a conventional non-steroidal anti-inflammatory drug after a heart attack increases the risk of death, according to a Danish study reported on 13 November at the Annual Scientific Sessions of the American Heart Association.

The investigators found that high-dose treatment with either diclofenac, ibuprofen or other NSAIDs or with the COX-2 inhibitors – Pfizer’s Celebrex (celecoxib) and Merck & Co’s now-withdrawn Vioxx (rofecoxib) - was particularly risky. However, low doses of the COX-2 inhibitors were also associated with a significantly higher risk of death, which was not observed with low doses of ibuprofen and diclofenac.

However, on the positive side, investigators did not find an increased risk of a second heart attack with any of the drugs or doses, and are analysing death certificates to see whether any causes of death were more common in patients taking COX-2 inhibitors and NSAIDs. In the meantime, this study threatens to add yet another nail in the COX-2 inhibitors’ coffin, and leaves doctors with a dilemma: how to treat arthritic pain effectively in patients who have had a heart attack.

Source: Sue Lyon at the AHA in Dallas, USA.