Sibilia Jean, Deray Gilbert, Montalescot Gilles
Service de Rhumatologie,CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg 67000.
Presse Med. 2006 Sep;35(9 Spec No 1):1S11-23.
Following the arterial thrombotic risk of rofecoxib (myocardial infarct and cerebral ischemic accidents) that led to its withdrawal from the market, the other coxibs then the NSAIDs have also been blacklisted. The factors responsible for the cardiovascular risk associated with the ingestion of the NSAIDs, selective or not, are not clearly identified. The objective of this review was to collect the available data from the literature, in order to better evaluate of the risk and its causes, principally on the basis of the results of randomised studies, but also of case reports and meta-analyses. There is an increase in the risk of arterial thrombotic events under coxibs and traditional NSAIDs, however the risk is variable for both classes. The cardiovascular risk linked to celecoxib seems variable and modest, and at a standard dose and for usual treatment durations, the risk is probably inexistant. While the real risk of classical NSAIDs is difficult to appreciate from the available results, it can be concluded that the cardiovascular risk of naproxen is low. While part of the cardiovascular consequences of rofecoxib could be associated with increased arterial pressure, these effects are not exclusive to the coxibs since they have been observed with the conventional NSAIDs. However the increase in arterial pressure cannot probably explain everything. Similarly the cardiac insufficiency associated more particularly with rofecoxib, especially in some groups of patients (very old subjects) is not a new type of complication and does not seem to be more frequent with coxibs than with classical NSAIDs. No short-term arterial thrombotic risk of the coxibs and NSAIDs has been clearly demonstrated.
鉴于罗非昔布存在动脉血栓形成风险（心肌梗死和脑缺血性意外）而导致其退市，随后其他昔布类药物以及非甾体抗炎药（NSAIDs）也都被列入黑名单。与服用NSAIDs（无论是否为选择性NSAIDs）相关的心血管风险因素尚未明确确定。本综述的目的是收集文献中的现有数据，以便更好地评估风险及其成因，主要依据随机研究的结果，同时也参考病例报告和荟萃分析的结果。使用昔布类药物和传统NSAIDs时，动脉血栓形成事件的风险会增加，然而这两类药物的风险都是可变的。与塞来昔布相关的心血管风险似乎是可变且适度的，在标准剂量和常规治疗疗程下，风险可能不存在。虽然从现有结果难以确切评估传统NSAIDs的实际风险，但可以得出结论，萘普生的心血管风险较低。虽然罗非昔布的部分心血管后果可能与血压升高有关，但这些影响并非昔布类药物所特有，因为在传统NSAIDs中也观察到了这些影响。然而，血压升高可能无法解释所有问题。同样，与罗非昔布更特别相关的心力衰竭，尤其是在某些患者群体（非常老年的患者）中，并不是一种新型并发症，而且似乎在昔布类药物中并不比传统NSAIDs更常见。尚未明确证实昔布类药物和NSAIDs存在短期动脉血栓形成风险。
