Can celecoxib (Celebrex) increase the risk for bleeding?

From the Guidelines

Celecoxib can increase the risk for bleeding, particularly in patients with certain risk factors, such as advanced age, history of gastrointestinal bleeding, or concurrent use of anticoagulants. According to the study published in the American Family Physician in 2009 1, the risk of gastrointestinal bleeding with celecoxib is dependent on age and patient history, with a one-year risk of one in 2,100 adults younger than 45 and one in 110 adults older than 75.

Key Risk Factors

• Advanced age
• History of gastrointestinal bleeding
• Concurrent use of anticoagulants, such as warfarin
• Concurrent use of antiplatelet drugs, such as aspirin or clopidogrel
• High doses of celecoxib, above 200mg daily

The mechanism behind this risk involves celecoxib's inhibition of prostaglandin synthesis, which affects platelet function and the protective mechanisms of the gastrointestinal mucosa 1. Patients taking celecoxib should be monitored for signs of bleeding, such as black tarry stools, blood in vomit, or unusual bruising, and should promptly report these symptoms to their healthcare provider.

Preventive Measures

• Combining celecoxib with a proton pump inhibitor (PPI) or misoprostol (Cytotec) may help reduce the risk of gastrointestinal bleeding 1
• Avoiding NSAIDs, including celecoxib, in patients with a history of NSAID-associated upper GI tract bleeding or elevated risk of myocardial infarction is recommended 1

From the FDA Drug Label

NSAIDs, including celecoxib capsules, may increase the risk of bleeding events. Co-morbid conditions such as coagulation disorders or concomitant use of warfarin, other anticoagulants, antiplatelet drugs (e.g., aspirin), SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) may increase this risk. The concomitant use of Celecoxib and anticoagulants have an increased risk of serious bleeding compared to the use of either drug alone.

Key Points:

• Celecoxib may increase the risk of bleeding events.
• Concomitant use of celecoxib with anticoagulants, antiplatelet drugs, SSRIs, and SNRIs may increase the risk of bleeding.
• Patients with co-morbid conditions such as coagulation disorders are at higher risk of bleeding.

2 and 2

From the Research

Celecoxib and Bleeding Risk

• The use of celecoxib may increase the risk of bleeding, particularly in patients taking anticoagulant medications such as warfarin 3.
• A study published in the Southern Medical Journal found that a patient taking celecoxib and warfarin experienced gastrointestinal bleeding and hypoprothrombinemia less than a week after starting celecoxib therapy 3.
• However, other studies have shown that celecoxib has a lower risk of gastrointestinal bleeding compared to non-selective NSAIDs 4, 5.
• The risk of bleeding with celecoxib is thought to be related to its effect on platelet function, although one study found that therapeutic doses of celecoxib did not affect platelet function 5.
• A review of the clinical data on celecoxib found that it is a safe and effective treatment for arthritis and pain, with a lower risk of gastrointestinal side effects compared to non-selective NSAIDs 5.
• However, another study found that the use of COX-2 inhibitors, including celecoxib, may increase the risk of cardiovascular events, including bleeding, particularly at high doses 6.
• The clinical pharmacology of celecoxib suggests that it has anti-inflammatory and analgesic properties, with a small and comparable risk of cardiovascular toxicity to traditional NSAIDs in short-term treatments 7.