Cardiovascular Safety of Celecoxib after Cardiac Surgery with Cardiopulmonary Bypass: A Retrospective Cohort Study

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  • Nahara Isao
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
  • Takeuchi Masato
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
  • Tanaka Shiro
    Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University
  • Yonekura Hiroshi
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University Department of Clinical Anesthesiology, Graduate School of Medicine Faculty of Medicine, Mie University
  • Takeda Chikashi
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University Department of Anesthesia, Kyoto University Hospital
  • Kawakami Koji
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University

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Abstract

<p>BACKGROUND</p><p>Cardiac surgery is a highly invasive procedure resulting in hypercoagulability due to thoracotomy and cardiopulmonary bypass (CPB). The long-term use of selective cyclooxygenase-2 inhibitors has been shown to increase the risk of adverse cardiovascular (CV) events such as myocardial infarction. This study aimed to determine whether short-term prescription of celecoxib increases CV events in patients who have undergone cardiac surgery with CPB.</p><p>METHODS</p><p>This retrospective observational study included 16,141 patients (≥20 years) who had undergone cardiac surgery with CPB between April 1, 2008 and March 31, 2016. Patients who underwent coronary artery bypass grafting were excluded. Patients who received celecoxib (n = 904) and acetaminophen (n = 5,002) from postoperative day 0 to 30 were extracted and matched by propensity score (PS). The primary outcomes were all-cause death and CV events, defined as coronary artery disease, ischemic stroke, pulmonary embolism, and venous thrombosis, coded using International Classification of Diseases-10 within 30 days after the first postoperative prescription of either medication. Results were assessed using Kaplan-Meier survival analysis and multivariate Cox regression analysis.</p><p>RESULTS</p><p>PS matching created 885 pairs. Multivariate Cox regression analysis showed that prescription of celecoxib after cardiac surgery was not associated with an increase in the primary outcomes when compared with prescription of acetaminophen (hazard ratio, 0.76; 95% confidence interval, 0.35–1.65).</p><p>CONCLUSIONS</p><p>The prescription of celecoxib in patients who had undergone cardiac surgery with cardiopulmonary bypass was not statistically different from the prescription of acetaminophen in the incidence of CV events and death.</p>

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