In Geriatric Women With Osteoarthritis What Is the Effect of Cox-2 Inhibitors on GI Bleeding Compared With Other NSAIDS, Essay Example

Narrative Statement

COX-2 selective inhibitors are relatively new non-steroidal anti-inflammatory drugs, used to relieve pain in patients who suffer from such diseases as arthritis, tendinitis, and bursitis. By directly affecting COX-2 enzyme, these medications propose a new concept of treatment. Celebrex, Bextra, and Vioxx are common types of inhibitors, which appeared on the market in 1999. Reviews about the side effects of most drugs from COX-2 group are still contradictory. On the one hand, the risk of serious side effects in patients remains relatively low. According to E. Rahme, associate professor of Department of Epidemiology and Biostatistics in McGrill University, “serious upper GI adverse events of gastric and duodenal ulcers, perforations and bleeding (PB) affect 1–2% of patients receiving these medications. PB’s often require hospitalization and have been estimated to cause the death of one in every 1220 chronic NS-NSAID users”. (Rahme, 2007) On the other, “the risk of complications is higher in elderly patients, rheumatoid arthritis sufferers, patients taking blood thinning medications (anticoagulants such as Coumadin and heparin) or prednisone (cortisone medication), and patients with heart disease or a prior history of bleeding ulcers”. (MedicineNet, 2005)

An article, entitled “COX-2-Selective Inhibitors and the Risk of Upper Gastrointestinal Bleeding in High-Risk Patients With Previous Gastrointestinal Diseases: A Population-Based Case-Control Study” and published in Alimentary Pharmacology and Therapeutics, describes a research held by Dutch scientists regarding the number of complication in old patients. Researchers have examined sample of both men and women of various age categories. According to the obtained data, “COX-2-selective inhibitors, especially celecoxib, were associated with a lower risk of upper gastrointestinal bleeding than were non-selective, non-aspirin NSAIDs in patients with previous gastrointestinal diseases or diseases predisposing to upper gastrointestinal bleeding” (Norgand, 2004). The results were similar for geriatric women with osteoarthritis. In women, risk of complications connected with the use of celecoxib, rofecoxib was estimated 1.3 and 2.1 % respectively, while complications connected with the use of other NSAIDs was estimated 3.3 %.

The research published in St. Luke’s Episcopal Health System also addresses osteoarthritis treatment options. According to the information highlighted in this source, the effectiveness of the use of COX-2 inhibitors in treatment geriatric women is also essential. Despite of the negative effects, which are usually associated with these medications, “studies are reporting a lower incidence of ulcers and other toxic side effects in patients taking the COX-2 inhibitors than in those taking NSAIDs” (St. Luke’s Episcopal Health System, 2001). In fact, such NSAID inhibitors as fenoprofen, indomethacin, flurbiprofen, piroxicam and other is considered to be of the highest risk.

Identification of the Studies Reviewed

Accurate and most recent data for the identification of the studies has been explored in different search engines. Based on the information received in class and through additional reading writer has detected professional medical and nursing journals.  Searching relevant data, various sources were identified neglecting the country or origin of the source with respect only to the accuracy and credibility of the materials proposed. Those journals or websites, which contain no mathematical data as a proof of the accuracy of the information used in this work, are supported by more reliable ones.

Summary of the Evidence Base

“Hospitalization for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study” article supports the idea that the use of COX-2 inhibitors is effective in 98% of all examined cases. Percent of complications is too small to recall these medications from health care institutions as it proposes pail relief to severe diseases. Research published by B. Norgald provides readers with accurate statistics on risk complications of women with osteoarthritis aged 65 and older. Scientists examine 780 cases and construct 95 % confidence interval on the number of risk complications in this sex and age category in comparison to other NSAID inhibitors. Information retrieved from Luce’s Episcopal Health System’s Website describes risk associated with both COX-2 inhibitors and other types of NSAID group. MedicineNet gives general description of the effectiveness of COX-2 inhibitors and addresses possible side affect, the number of which growth depending on the age of the patients and the frequency of medications usage.

Strengths and Limitations of the Evidence Base

Both works of B. Norgald and E. Rahme are researches maintained by associate professors of health care institutions. These are team-based projects, which examine relatively large populations and samples. Therefore, data provided in these works is accurate and gives the reader objective information about true statistics and risk possibilities of COX-2 inhibitors in comparison to other types of NSAID group. Secondly, these researches examine various cased of the patients of different sex, age and social status. The only limitation of these sources is rather old information as the investigations took place in 2004 and 2006 respectively. St. Luce’s Episcopal Health System’s website contains information about various risk factors categorized not only by the types of inhibitors, but also historically. Moreover, it depicts the degree of the possible complication if various medications are used. MedicineNet source is useful as it describes the way NSAIDs cause bleeding. Though this article also addresses side effects of these medications, it does not contain a lot of credible background.

Discussion of How the Limitations Affect the Readiness of the New Intervention for Use in Clinical Practice

Based on the evidence highlighted in these sources, writer was convinced that in geriatric women with osteoarthritis the risk of GI bleeding is relatively small when using COX-2 inhibitors. In fact, the reviewed researches legitimize the use of these medications and support the idea that their usage is more effective in comparison with other NSAIDs. Secondly, though there is certain percentage of complications, their number is too small to recall selling of these non-steroidal anti-inflammatory drugs. Nonetheless, the writer should do further research in order to examine the most recent information about COX-2 inhibitors, because several issues still remain unclear.

References

Norgand, B., Pedersen, L., Johnsen, S. P., Tarone, R. E. (April 22, 2004). COX-2-Selective Inhibitors and the Risk of Upper Gastrointestinal Bleeding in High-Risk Patients With Previous Gastrointestinal Diseases: A Population-Based Case-Control Study. Alimentary Pharmacology and Therapeutics. Retrieved April 26, 2009 from http:/ /www.medscape.com/viewarticle/472655.

MedicineNet. (2005). Cox-2 Inhibitors. Retrieved April 26, 2009 from http:/ /www.medicinenet.com/cox-2_inhibitors/article.htm.

Rahme, E., Bardou, M., Dasgupta, K. (July 13, 2006). Hospitalization for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study. Rheumatology. Volume 46, Number 2. Retrieved April 26, 2009 from http:/ /rheumatology. oxfordjournals.org/cgi/content/full/46/2/265.

St. Luce’s Episcopal Health System. (2001). Osteoarthritis Treatment Options. Retrieved April 26, 2009 from http://www.sleh.com/sleh/Section004/index.cfm?pagename=Osteoarthritis&PageMD=OSTEOARTHRITIS&objectid=8A954F9E-87A2-11D6-A7DD00B0D06875AD.