Page 110 - Athletic Health Handbook
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25 mg/day (RR=1.73) compared
with placebo. The relative risk of
MI was even greater (RR=2.70) with
celecoxib at 400 mg/day or higher.
Among the older NSAIDs, only
naproxen was not associated with
an increased cardiovascular risk
(naproxen, RR=0.92; diclofenac,
RR=1.63; ibuprofen, RR=1.51).

Gastrointestinal Risks of COX-1
and COX-2 NSAIDs

Several studies have documented
upper gastrointestinal complications
associated with non-selective NSAID
use. Weil et al27 showed a 4-fold rela-
tive risk of upper GI complications
with the use of traditional NSAIDs.
When aspirin and NSAID usage was
combined, the relative risk rose nearly
8-fold. Lewis et al28 found that over-
the-counter (OTC) NSAIDs used
longer than four days had an
adjusted odds ratio (OR) of 1.83 for
GI toxicity while OTC NSAID use
for less than four days had no such
risk (OR=0.67). Finally, Allison et
al29 demonstrated a statistically signif-
icant increase of death secondary to
GI toxicity from COX-1 NSAID
use when compared to placebo.

A lower incidence of GI events
with COX-2 inhibitors has been
reported when compared to COX-1
NSAIDs. Peura et al20 noted a nearly
10-fold increase in mucosal damage
with ibuprofen compared to placebo,
in contrast to COX-2 inhibitors that
were found to have a similar incidence
of GI events as placebo. Recently,
proton pump inhibitor therapy has
been shown to prevent and assist in
the management of NSAID-related
GI damage.30

Impact of NSAIDs on Bone
and Soft Tissue Injury

The use of NSAIDs has been evalu-
ated in the management of bone,
ligament, muscle, and tendon injury.
Their efficacy in promoting healing

COX-2 INHIBITORS AND NON-SELECTIVE NSAIDS 110
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