Balancing Risks and Benefits of Cyclooxygenase-2 Selective Nonsteroidal Anti-Inflammatory Drugs

The recognition that nonsteroidal anti-inflammatory drugs (NSAIDs) increase not only gastrointestinal (GI) but cardiovascular (CV) adverse events as well has created a dilemma for practicing physicians. Clinicians selecting appropriate NSAID therapy must estimate each patient's baseline risk for both (GI) and (CV) adverse events, and then estimate the impact of each medication (and its dose) for the individual patient. To synthesize a rational current treatment approach, we have developed a 2x2 table to guide NSAID medication choice, considering the use of concomitant aspirin as well as gastroprotective therapy. COX-2 inhibitors were an important scientific advance in pain therapy, and using them in a safe and cost-effective manner is possible when all the competing risks are carefully weighed.