Complications of the COX-2 Inhibitors Parecoxib and Valdecoxib after Cardiac Surgery

When administered to patients for pain control after coronary-artery bypass surgery, valdecoxib and its intravenous prodrug, parecoxib, were found to be associated with an increased risk of cardiovascular thromboembolic events. These findings add to the growing concern that the use of COX-2 inhibitors increases the risk of cardiovascular events, particularly in persons who are at risk for such events. When administered to patients for pain control after coronary-artery bypass surgery, valdecoxib and its intravenous prodrug, parecoxib, were found to be associated with an increased risk of cardiovascular thromboembolic events. Nonsteroidal antiinflammatory drugs (NSAIDs) are established pharmacologic tools for treating postoperative pain. However, concern about the possibility of gastric ulceration, renal injury, and bleeding has limited the use of NSAIDs in some surgical and critical care settings. 1 The selective cyclooxygenase-2 (COX-2) inhibitor valdecoxib (Bextra, Pfizer) and its intravenous prodrug parecoxib (Dynastat, Pfizer) were found to exert significant opioid-sparing effects after dental, gynecologic, orthopedic, and other noncardiac surgical procedures, apparently without causing serious adverse effects. 2 – 5 Similar efficacy was demonstrated in a study of parecoxib and valdecoxib in patients recovering from coronary-artery bypass grafting (CABG). 6 In that study, however, these drugs . . .