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Riesgo cardiovascular derivado de los inhibidores selectivos de la ciclooxigenasa
Resumen
Alrededor de 30 millones de personas toman diariamente un antiinflamatorio no esteroide (AINE), cuyas indicaciones básicas son la disminución del dolor y la mejoría de la función articular. La intolerancia gastrointestinal que pueden provocar llevó al desarrollo de los inhibidores selectivos de la ciclooxigenasa-2 (COXIB), con un mejor perfil de seguridad gastrointestinal. Sin embargo, desde 1999 se ha demostrado que los COXIB producen eventos adversos cardiovasculares. Otros estudios ratificaron una mayor frecuencia de eventos adversos cardiovasculares independientemente del uso de aspirina como antiagregante. Esto ha llevado a suponer que se trata de un efecto de clase de los COXIB, por lo que antes de su utilización se sugiere evaluar el riesgo cardiovascular. Los pacientes con factores de riesgo gastrointestinal y sin riesgo cardiovascular pueden utilizar un AINE más un agente gastroprotector o un COXIB. Aun cuando algunos medicamentos, como el rofecoxib, han salido del mercado por el aumento en el riesgo cardiovascular, se siguen utilizando libremente otros COXIB. Por este motivo se hace una revisión de la seguridad cardiovascular de los AINE tradicionales y de los COXIB, con el fin de conocer ventajas y limitaciones de este grupo de medicamentos.
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