Abstract
Gastrointestinal side effects from nonsteroidal anti-inflammatory drugs (NSAIDs) result mainly from inhibition of the enzyme cyclooxygenase (COX)-1; it is responsible for the synthesis of prostaglandin E2, which leads to increased mucosal blood flow, increased bicarbonate secretion, and mucus production, thus protecting the gastrointestinal mucosa. In inflammation, COX-2 is induced, causing synthesis of the prostaglandins in conditions such as osteoarthritis and rheumatoid arthritis. Two NSAIDs (celecoxib and rofecoxib) with very high specificity for COX-2 and virtually no activity against COX-1 at therapeutic doses have been approved for clinical use. In trials of celecoxib and rofecoxib, only 0.02% of patients had clinically significant gastrointestinal bleeding, compared to a 1% to 2% yearly incidence of severe gastrointestinal side effects with NSAIDs. Our patient had arthritis of the hips and chronic atrial fibrillation and was on warfarin therapy for stroke prevention; less than a week after starting celecoxib therapy, gastrointestinal bleeding and hypoprothrombinemia occurred.
Publication types
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Case Reports
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Comparative Study
MeSH terms
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Aged
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Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
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Anticoagulants / therapeutic use
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Arthritis / drug therapy
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Atrial Fibrillation / drug therapy
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Bicarbonates / metabolism
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Celecoxib
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Cyclooxygenase 2
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Cyclooxygenase 2 Inhibitors
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Cyclooxygenase Inhibitors / adverse effects*
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Dinoprostone / antagonists & inhibitors
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Gastric Mucosa / blood supply
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Gastric Mucosa / drug effects
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Gastrointestinal Hemorrhage / chemically induced*
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Hip Joint
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Humans
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Hypoprothrombinemias / chemically induced*
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Incidence
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Intestinal Mucosa / blood supply
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Intestinal Mucosa / drug effects
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Isoenzymes / antagonists & inhibitors*
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Lactones / adverse effects
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Male
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Membrane Proteins
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Mucus / drug effects
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Peroxidases / antagonists & inhibitors*
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Prostaglandin-Endoperoxide Synthases
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Pyrazoles
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Sulfonamides / adverse effects*
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Sulfones
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Warfarin / therapeutic use
Substances
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Anti-Inflammatory Agents, Non-Steroidal
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Anticoagulants
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Bicarbonates
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Cyclooxygenase 2 Inhibitors
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Cyclooxygenase Inhibitors
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Isoenzymes
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Lactones
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Membrane Proteins
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Pyrazoles
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Sulfonamides
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Sulfones
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rofecoxib
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Warfarin
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Peroxidases
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Cyclooxygenase 2
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PTGS2 protein, human
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Prostaglandin-Endoperoxide Synthases
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Celecoxib
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Dinoprostone