Risks of colorectal neoplasms and cardiovascular thromboembolic events after the combined use of selective COX‐2 inhibitors and aspirin with 5‐year follow‐up: a meta‐analysis

Abstract

Aim We aimed to evaluate the association between selective COX‐2 inhibitors (coxibs) and the risk of colorectal neoplasms and vascular events with and without low‐dose aspirin. Method We searched for randomized controlled trials and comparative studies in PubMed, EMBASE and Cochrane Library databases using pertinent key terms. Risk ratios (RRs) were calculated for each study with a fixed‐ or random‐effects model. Results Eight clinical studies with 44 566 subjects were eligible. The use of coxib significantly reduced the overall risk of colorectal neoplasms by 21% (RR = 0.79, 95% CI 0.70−0.89; P = 0.000). The chemopreventive effect of coxibs was beneficial in the first year (RR = 0.74, 95% CI 0.58–0.94; P = 0.013), marginal in the third year (RR = 0.79, 95% CI 0.63−1.01; P = 0.059) and counterproductive in the fifth year (RR = 1.65, 95% CI 1.23−2.21; P = 0.001). Compared with the use of aspirin alone, combined use of coxib and aspirin for 3 years increased the risk of a colorectal neoplasm by 80% in the fifth year (RR = 1.80, 95% CI 1.22−2.66; P = 0.003) but decreased by 79% and 30%, respectively, the risks of cardiovascular thromboembolic events (RR = 1.79, 95% CI 1.33−2.41; P = 0.0001) and renal impairment/hypertension (RR = 1.30, 95% CI 1.09−1.54; P = 0.003) caused by coxib use alone. Conclusion Coxibs may reduce the overall risk of colorectal neoplasms, but the chemopreventive effects are attenuated over time. When participants take low‐dose aspirin simultaneously, coxibs may not be useful for chemoprevention of colorectal neoplasm.

Efficacy and safety of antiplatelet agents in patients with COVID-19 a systematic review and meta-analysis of observational studies

“…Patients with COVID-19 has a high incidence of thromboembolic events [22]. Among non-COVID-19 patients, antiplatelet agents are strongly related to a lower incidence of thrombotic events [23]. But our results showed that treatment with antiplatelet agents was not associated with mortality in COVID-19 patients.…”

Bioactive C17 and C18 Acetylenic Oxylipins from Terrestrial Plants as Potential Lead Compounds for Anticancer Drug Development

“…Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin are known COX inhibitors, and they have been widely used for cancer prophylaxis [200]. However, several adverse effects have been associated with the long-term usage of NSAIDs such as gastrointestinal bleeding, asthma, hepatic, renal and cardiovascular toxicity, primarily due to their irreversible inhibition of COX enzymes and in particular COX-1; hence, their clinical application has been limited [201]. Consequently, dietary secondary metabolites such as polyacetylenes that are known for their cytotoxic and anti-inflammatory activities have therefore been considered as promising chemopreventive candidates because they inherently show low toxicity and a promising safety profile with no known severe side effects.…”

Dietary Polyacetylenic Oxylipins Falcarinol and Falcarindiol Prevent Inflammation and Colorectal Neoplastic Transformation: A Mechanistic and Dose-Response Study in A Rat Model

“…Nonsteroidal anti-inflammatory drugs (NSAIDs) are known COX inhibitors, and they have been widely used for cancer prophylaxis; also, epidemiological studies have found them to have chemopreventive potential [13]. However, several adverse effects, including gastrointestinal bleeding, asthma, hepatic, renal and cardiovascular toxicity have been associated with their long-term usage, and hence their clinical application has been limited [14]. In this context, dietary bioactive natural products have attracted a great deal of research interest because they inherently show low toxicity and a promising safety profile with no known severe side effects [15].…”