做选择性cyclo-oxygenase-2抑制剂和传统的非甾体抗炎药增加壁血栓的风险?随机试验的荟萃分析。
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卡尼点,b C,古德温J,大厅H,小埃柏森,Patrono C
做选择性cyclo-oxygenase-2抑制剂和传统的非甾体抗炎药增加壁血栓的风险?随机试验的荟萃分析。
BMJ。2006年6月3;332 (7553):1302 - 8。
- PubMed ID
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16740558 (在PubMed]
- 文摘
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目的:评估的影响选择性cyclo-oxygenase-2 (COX - 2)抑制剂和传统的非甾体抗炎药(非甾体抗炎药)血管事件的风险。设计:荟萃分析发表和未发表的表格数据的随机试验,间接估计的传统非甾体抗炎药的影响。数据来源:Medline和Embase(1966年1月至2005年4月);食品和药物管理局的记录;从诺华和数据文件,辉瑞和默克公司。随机试验评估方法:入选的研究,其中包括比较选择性COX 2抑制剂与安慰剂或选择性COX 2抑制剂与传统的非甾体抗炎药,至少4个星期的时间,信息严重血管事件(定义为心肌梗死,中风,或血管性死亡)。个人调查人员和制造商提供的信息数量的患者随机,数量的血管事件,和后续的人时间为每个随机群体。结果:在安慰剂组比较,分配选择性COX - 2抑制剂与相对增加42%严重血管事件的发生率(1.2% v /年0.9% /年;率比为1.42,95%置信区间1.13 - 1.78;P = 0.003),无明显异质性之间的不同的选择性COX 2抑制剂。 This was chiefly attributable to an increased risk of myocardial infarction (0.6%/year v 0.3%/year; 1.86, 1.33 to 2.59; P = 0.0003), with little apparent difference in other vascular outcomes. Among trials of at least one year's duration (mean 2.7 years), the rate ratio for vascular events was 1.45 (1.12 to 1.89; P = 0.005). Overall, the incidence of serious vascular events was similar between a selective COX 2 inhibitor and any traditional NSAID (1.0%/year v 0.9%/year; 1.16, 0.97 to 1.38; P = 0.1). However, statistical heterogeneity (P = 0.001) was found between trials of a selective COX 2 inhibitor versus naproxen (1.57, 1.21 to 2.03) and of a selective COX 2 inhibitor versus non-naproxen NSAIDs (0.88, 0.69 to 1.12). The summary rate ratio for vascular events, compared with placebo, was 0.92 (0.67 to 1.26) for naproxen, 1.51 (0.96 to 2.37) for ibuprofen, and 1.63 (1.12 to 2.37) for diclofenac. CONCLUSIONS: Selective COX 2 inhibitors are associated with a moderate increase in the risk of vascular events, as are high dose regimens of ibuprofen and diclofenac, but high dose naproxen is not associated with such an excess.
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