What Are The Early Warning Signs Of Lung Cancer?
Health
What is Lung Cancer?
Lung cancer is almost always caused by cigarette smoking. Many times it’s not diagnosed until the later stages of the disease which normally means that it has already spread to other tissue and organs. It’s also the leading cause of cancer deaths in the US in both men and women which is sad as the risks of developing it significantly decrease if a person does not smoke.
What are the early warning signs?
Lung cancer has many symptoms however some of the earliest signs can be mistaken for common everyday illnesses. Many of the symptoms of lung cancer do not show up until the cancer is in a later stage. Some of the early warning signs can include:
• Persistent Cough
• Recurrent Bronchitis or Pneumonia
• Loss of Appetite, Weight Loss
• Chest Pain
Some of the additional symptoms of Lung Cancer are listed below. While having any of these symptoms does not mean you have cancer, a Dr. should be consulted if you are suffering from any of the following:
• Fever without a known reason
• Abnormal Chest X-ray
• Coughing Up Blood
• Hoarseness
• Chronic Shortness of Breath
If you are suffering from any or several of these symptoms and you are a current or former smoker, you should contact your physician and schedule an appointment to have an examination. There are tests that can be done to determine the cause of your symptoms and these tests can either diagnose or rule out lung cancer. Some of the tests available include a blood count test, X-ray as well as bone scan or sputum exam.
Conclusion
If you are a smoker and are concerned about any of the symptoms you are experiencing remember the sooner you are diagnosed the better. Cancer can spread very rapidly and by beginning treatments as soon as possible you can improve your chance of survival. They say a picture is worth a thousand words. To see for yourself the harsh reality of what cancer can do, please visit: Pictures of Lung Cancer as soon as possible. These images will show you why it’s so important to stop smoking as soon as possible. http://stopsmokingonlinetoday.comis a website that's dedicated in helping people quit smoking.
Thursday, July 30, 2009
Saturday, June 6, 2009
Malpractice Lawyer Help
The following piece deals with using a lawyer in this local area and how the choice can help your case.
Healing With The Aid Of Your San Antonio Malpractice Lawyer by San Antonio Malpractice Lawyer
The rising costs of medical care are downright scary. Scarier yet are the recently released reports regarding medical mistakes. With physicians and nursing staff cut backs, ER layoffs and specialists getting paid less for working more hours, people are getting hurt. If you are the victim of a medical mistake, call your local San Antonio malpractice lawyer to start your claim today.
Malpractice can occur in many ways. Some of the most common incidences in medical malpractice are misdiagnosis, prescribing the wrong medication, removing or operating the wrong body part, and leaving instruments inside of a person after surgery. These can all lead to very complicated medical conditions, illness, or even death. If you feel you have a basis for a San Antonio malpractice case, you should pursue the matter as soon as you are capable, as there is a time limit to injury claims.
It is not uncommon for a hospital to attempt to cover up such mistakes, therefore it is sometimes hard to gather sufficient evidence to support your claim. If a loved one has died under circumstances that you found very odd, you should consult a malpractice lawyer immediately, as they will have the resources available to obtain necessary records from the hospital that could serve as basis for a malpractice lawsuit. If your lawyer is able to prove that the practice or professional was indeed at fault for the death, the closest living relative is usually granted a reasonable amount of money to compensate for the loss.
One thing you should be prepared to stand firm against are the doctor's and hospital's insurance companies They have a reputation for dogging people with smooth "legal jargon" and try to convince a patient that the doctor or hospital is not at fault and that the case will not stand in court. They work by demoralizing you until you feel as though the pursuit for justice and compensation is futile and you back down. It is best to simply refuse to talk to any insurance company representatives without the presence of a San Antonio attorney to aid you.
To make sure that you truly have the best chance possible of obtaining justice, you should seek out a malpractice expert as soon as possible after the incident. Be aware that there is a time limit on how long you can wait to file a case after the malpractice occurs. Not only will a malpractice lawyer be able to guide you through the entire process with confidence and experience, but he will also make sure that you truly get what you deserve in recompense, rather than settling for a pittance offered by the opposing party as a means to mollify you. Keep in mind that by keeping quiet about an incident could open other patients up to the same experience you had--or worse.
http://www.sanantoniomalpracticelawyer.net
Have a legal problem? Come to LegalMatch and find pre-screened, qualified lawyers in your local area.
Healing With The Aid Of Your San Antonio Malpractice Lawyer by San Antonio Malpractice Lawyer
The rising costs of medical care are downright scary. Scarier yet are the recently released reports regarding medical mistakes. With physicians and nursing staff cut backs, ER layoffs and specialists getting paid less for working more hours, people are getting hurt. If you are the victim of a medical mistake, call your local San Antonio malpractice lawyer to start your claim today.
Malpractice can occur in many ways. Some of the most common incidences in medical malpractice are misdiagnosis, prescribing the wrong medication, removing or operating the wrong body part, and leaving instruments inside of a person after surgery. These can all lead to very complicated medical conditions, illness, or even death. If you feel you have a basis for a San Antonio malpractice case, you should pursue the matter as soon as you are capable, as there is a time limit to injury claims.
It is not uncommon for a hospital to attempt to cover up such mistakes, therefore it is sometimes hard to gather sufficient evidence to support your claim. If a loved one has died under circumstances that you found very odd, you should consult a malpractice lawyer immediately, as they will have the resources available to obtain necessary records from the hospital that could serve as basis for a malpractice lawsuit. If your lawyer is able to prove that the practice or professional was indeed at fault for the death, the closest living relative is usually granted a reasonable amount of money to compensate for the loss.
One thing you should be prepared to stand firm against are the doctor's and hospital's insurance companies They have a reputation for dogging people with smooth "legal jargon" and try to convince a patient that the doctor or hospital is not at fault and that the case will not stand in court. They work by demoralizing you until you feel as though the pursuit for justice and compensation is futile and you back down. It is best to simply refuse to talk to any insurance company representatives without the presence of a San Antonio attorney to aid you.
To make sure that you truly have the best chance possible of obtaining justice, you should seek out a malpractice expert as soon as possible after the incident. Be aware that there is a time limit on how long you can wait to file a case after the malpractice occurs. Not only will a malpractice lawyer be able to guide you through the entire process with confidence and experience, but he will also make sure that you truly get what you deserve in recompense, rather than settling for a pittance offered by the opposing party as a means to mollify you. Keep in mind that by keeping quiet about an incident could open other patients up to the same experience you had--or worse.
http://www.sanantoniomalpracticelawyer.net
Have a legal problem? Come to LegalMatch and find pre-screened, qualified lawyers in your local area.
Wednesday, May 20, 2009
Viatical Life Insurance Settlement
Do you know the market value of your life insurance policy? You may have a large asset available as cash to you right now. A Viatical settlement is when an insured policy holder receives cash based on the value of the life insurance policy value. The policy is sold to a third party and the insured receives proceeds.
If you or your family owns life insurance that you no longer want because of high premiums, need for cash or other reason - you do not need to just let the policy last. We have buyers in the market who can price up your life policy for a cash settlement or transfer. A life option or viatical settlement allows for policyowners to sell their insurance for a high level cash payout.
Skip to form below to be contacted on possible cash options for your existing life policy.
With the advent of new financial and insurance technology, the amount of life insurance wealthy individuals can purchase usually exceeds the amount their beneficiaries require. The insured can profit during their lifetime, if this "excess" is managed properly.
The availability of a secondary market for life insurance policies ( viatical settlements ), is what makes this possible.
Who is best for a life or viatical cash settlement?
Those over age 65 or
Face amount of the policy is over $200,000
Advantages of a secondary market viatical settlement include:
Reduction or elimination of current premiums.
Reposition non income performing assets into income producing assetsand increasing net spendable income.
Provide assets to use as current gifts to heirs.
In the end, these policy sales are on a case by case basis. Using a professional insurance firm with the best possible market for these life issues will provide the insured with the best possible cash distribution or payout settlement.
If you are in need of legal advice or counsel, please provide thee basic bits of information. We cannot guarantee an accurate quote or be able to contact you without having as much information as possible.
We work with hundreds of buyer companies, so the best cash quote can be gained.
Viatical Life Settlements
Money For Life Insurance
If you or your family owns life insurance that you no longer want because of high premiums, need for cash or other reason - you do not need to just let the policy last. We have buyers in the market who can price up your life policy for a cash settlement or transfer. A life option or viatical settlement allows for policyowners to sell their insurance for a high level cash payout.
Skip to form below to be contacted on possible cash options for your existing life policy.
With the advent of new financial and insurance technology, the amount of life insurance wealthy individuals can purchase usually exceeds the amount their beneficiaries require. The insured can profit during their lifetime, if this "excess" is managed properly.
The availability of a secondary market for life insurance policies ( viatical settlements ), is what makes this possible.
Who is best for a life or viatical cash settlement?
Those over age 65 or
Face amount of the policy is over $200,000
Advantages of a secondary market viatical settlement include:
Reduction or elimination of current premiums.
Reposition non income performing assets into income producing assetsand increasing net spendable income.
Provide assets to use as current gifts to heirs.
In the end, these policy sales are on a case by case basis. Using a professional insurance firm with the best possible market for these life issues will provide the insured with the best possible cash distribution or payout settlement.
If you are in need of legal advice or counsel, please provide thee basic bits of information. We cannot guarantee an accurate quote or be able to contact you without having as much information as possible.
We work with hundreds of buyer companies, so the best cash quote can be gained.
Viatical Life Settlements
Money For Life Insurance
Tuesday, April 7, 2009
Peritoneal mesothelioma
The following is an expert piece related to asbestos exposure, disease, treatment and survival. Tens of thousands have become ill or died from various degrees of exposure and the types of related illness.
What is Peritoneal mesothelioma by Roger Sandoval
is a disease that affects the lining of the abdomen, or peritoneum. Occasionally doctors refer to this disease as mesothelioma of the peritoneum. It is a general misunderstanding that mesothelioma is a form of primary lung cancer; it is not. Mesothelioma is a cancer of the serous membranes. These membranes enclose a number of organs throughout the midsection of the body, as well as the abdomen. The most customary type of mesothelioma is pleural mesothelioma, which affects the serous membranes of the lungs.
The second most regular form of mesothelioma cancer is Peritoneal mesothelioma. Peritoneal mesothelioma can extend to the lungs and when this occurs, it is considered secondary lung cancer. Mesothelioma is also at times referred to as an asbestos lung cancer. Technically, this is also inexact, since it does not originate in the lungs. Asbestosis is a type of asbestos lung disease that does originate in the lungs and is often confused with Mesothelioma.
Peritoneal mesothelioma Cancer
Peritoneal mesothelioma cancer is found in 10 of the Mesothelioma patients. The solitary recognized cause of Mesothelioma is exposure to asbestos. For pleural Mesothelioma (cancer of the lung lining), the disease progression is reasonably well understood. It is initiated by the breathing of asbestos fibers that settle in the lungs. These asbestos fibers become interleaveed in the lung lining (or pleura). Asbestos fibers are very robust and cannot be eliminated through the body's processes. Over time, they cause recurring inflammation that eventually leads to growth of cancerous tumors or in some cases asbestosis.
For Peritoneal mesothelioma, it is not clearly understood how the asbestos fibers turn out to be wedged in the abdomen's peritoneum lining. It is likely that asbestos fibers, after being cracked into lesser pieces in the lungs, are carried from the lungs into the blood stream, and embed from the blood stream in the abdomen lining. A more probable basis is that asbestos fibers were consumeed with food or drink. Largely asbestos mining or processing facilities had persistent clouds of asbestos fibers. These fibers may perhaps have settled on the food of the workers. Also, it is well established that several of the workers' clothing became infiltrated with asbestos dust. This dust could have polluted the kitchens of the employees as they arrived home with the polluted clothing. Once lodged in the peritoneum, the chronic inflammation process leading to cancerous growths is similar to that occurring in pleural Mesothelioma.
Mesothelioma of the Testicles A infrequent form of Peritoneal mesothelioma affects the male testicles. The covering layer of the scrotum is essentially an outpouching of the peritoneum. It is accepted wisdom that the asbestos fibers migrate from the stomach area to become lodged in the portion of the peritoneum surrounding the scrotum.
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What is Peritoneal mesothelioma by Roger Sandoval
is a disease that affects the lining of the abdomen, or peritoneum. Occasionally doctors refer to this disease as mesothelioma of the peritoneum. It is a general misunderstanding that mesothelioma is a form of primary lung cancer; it is not. Mesothelioma is a cancer of the serous membranes. These membranes enclose a number of organs throughout the midsection of the body, as well as the abdomen. The most customary type of mesothelioma is pleural mesothelioma, which affects the serous membranes of the lungs.
The second most regular form of mesothelioma cancer is Peritoneal mesothelioma. Peritoneal mesothelioma can extend to the lungs and when this occurs, it is considered secondary lung cancer. Mesothelioma is also at times referred to as an asbestos lung cancer. Technically, this is also inexact, since it does not originate in the lungs. Asbestosis is a type of asbestos lung disease that does originate in the lungs and is often confused with Mesothelioma.
Peritoneal mesothelioma Cancer
Peritoneal mesothelioma cancer is found in 10 of the Mesothelioma patients. The solitary recognized cause of Mesothelioma is exposure to asbestos. For pleural Mesothelioma (cancer of the lung lining), the disease progression is reasonably well understood. It is initiated by the breathing of asbestos fibers that settle in the lungs. These asbestos fibers become interleaveed in the lung lining (or pleura). Asbestos fibers are very robust and cannot be eliminated through the body's processes. Over time, they cause recurring inflammation that eventually leads to growth of cancerous tumors or in some cases asbestosis.
For Peritoneal mesothelioma, it is not clearly understood how the asbestos fibers turn out to be wedged in the abdomen's peritoneum lining. It is likely that asbestos fibers, after being cracked into lesser pieces in the lungs, are carried from the lungs into the blood stream, and embed from the blood stream in the abdomen lining. A more probable basis is that asbestos fibers were consumeed with food or drink. Largely asbestos mining or processing facilities had persistent clouds of asbestos fibers. These fibers may perhaps have settled on the food of the workers. Also, it is well established that several of the workers' clothing became infiltrated with asbestos dust. This dust could have polluted the kitchens of the employees as they arrived home with the polluted clothing. Once lodged in the peritoneum, the chronic inflammation process leading to cancerous growths is similar to that occurring in pleural Mesothelioma.
Mesothelioma of the Testicles A infrequent form of Peritoneal mesothelioma affects the male testicles. The covering layer of the scrotum is essentially an outpouching of the peritoneum. It is accepted wisdom that the asbestos fibers migrate from the stomach area to become lodged in the portion of the peritoneum surrounding the scrotum.
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Cancer Trial Lawsuit - Mesothelioma Law
The following is a piece on a person who won a recent case against a shipbuilding company for mesothelioma. The person victorious in the lawsuit won over 4 million dollars.
Shipyard Worker Wins Mesothelioma Cancer Trial
Following a jury trial that lasted two and a half weeks, a Norfolk, Virginia man won a $4.39 million verdict on Sept. 5. John Koonce, 59, worked at Norfolk Shipbuilding and Drydock Corp. from 1967 to 1971 with asbestos containing parts such as John Crane gaskets and packing materials. In 2006, he was diagnosed with mesothelioma cancer, and he later had a lung removed.
Compensatory Damages and Medical Expenses
After a day of deliberation, the jury awarded Koonce both compensatory damages ($4 million) and medical expenses ($390,000) from John Crane Inc., an Illinois-based company. Koonce’s asbestos attorney Bobby Hatten of Patten, Wornom, Hatten & Diamonstein criticized Crane’s no-settlement policy, “Settlements are what reasonable companies do to resolve litigation…when that doesn’t happen, they get to face the jury.”
Hatten also noted that his firm spent two years on the case, with five lawyers assigned to the plaintiff’s issues. His firm will keep one-third of the award, or $1.46 million.
Defendant’s Appeal Is Possible
The defendant John Crane Inc. has the option to appeal the verdict; it has done so in similar cases in the past. Crane could also offer to not appeal in return for Koonce accepting a reduced award amount. A second party that Koonce named, Garlock Sealing Technologies, settled out of court.
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Shipyard Worker Wins Mesothelioma Cancer Trial
Following a jury trial that lasted two and a half weeks, a Norfolk, Virginia man won a $4.39 million verdict on Sept. 5. John Koonce, 59, worked at Norfolk Shipbuilding and Drydock Corp. from 1967 to 1971 with asbestos containing parts such as John Crane gaskets and packing materials. In 2006, he was diagnosed with mesothelioma cancer, and he later had a lung removed.
Compensatory Damages and Medical Expenses
After a day of deliberation, the jury awarded Koonce both compensatory damages ($4 million) and medical expenses ($390,000) from John Crane Inc., an Illinois-based company. Koonce’s asbestos attorney Bobby Hatten of Patten, Wornom, Hatten & Diamonstein criticized Crane’s no-settlement policy, “Settlements are what reasonable companies do to resolve litigation…when that doesn’t happen, they get to face the jury.”
Hatten also noted that his firm spent two years on the case, with five lawyers assigned to the plaintiff’s issues. His firm will keep one-third of the award, or $1.46 million.
Defendant’s Appeal Is Possible
The defendant John Crane Inc. has the option to appeal the verdict; it has done so in similar cases in the past. Crane could also offer to not appeal in return for Koonce accepting a reduced award amount. A second party that Koonce named, Garlock Sealing Technologies, settled out of court.
eHealthInsurance - FREE Instant Quotes!
www.nicksclassifieds.com - The free ad site with 120 day ad posting expiration. 4 times as long as craig's list!
Sunday, February 22, 2009
Class Action Asbestos Check - Settlement Estate
We received another settlement check from my dads class action attorney. It was $500 and something. The attorney fees are pretty crazy. I think the whole settlement on our end was $1250. Not complaining as we really don't have to do anything. We just collect when it's time.
I do not know how many other people our lawyer on these asbestos cases is working for. I'm guessing hundreds - maybe thousands. Really don't know.
I wonder how many of these companies are still around to even collect from as this stuff that went on with my dad and these merchant marines was 50 years ago. Not to mention the economy and the business bankruptcies.
I'm not sure how many other cases are pending or possible or how many years these settlement checks will continue. They aren't big medical death payout settlements usually. I think the largest estate payout we got was $7000 and that was several years ago.
Sell A Life Policy - Collect cash for insurance
I do not know how many other people our lawyer on these asbestos cases is working for. I'm guessing hundreds - maybe thousands. Really don't know.
I wonder how many of these companies are still around to even collect from as this stuff that went on with my dad and these merchant marines was 50 years ago. Not to mention the economy and the business bankruptcies.
I'm not sure how many other cases are pending or possible or how many years these settlement checks will continue. They aren't big medical death payout settlements usually. I think the largest estate payout we got was $7000 and that was several years ago.
Sell A Life Policy - Collect cash for insurance
Tuesday, January 13, 2009
Vioxx Risks
Increasing use of rofecoxib (Vioxx) and celecoxib (Celebrex), both selective inhibitors of COX-2, for treatment of arthritis has been accompanied by concerns that
they may increase the risk of thrombotic cardiovascular events.
Most older nonsteroidal anti-inflammatory drugs (NSAIDs)
decrease endothelial production of both thromboxane, which has a prothrombotic effect on platelets, and prostacyclin, which has an antithrombotic effect. The usual net effect is some inhibition of platelet function and prolongation of bleeding time. Platelet inhibition is reversible when the drug is cleared, except with aspirin, which has an antiplatelet effect for the life of the platelet, an average of about 7 days. Selective COX-2 inhibitors decrease production of prostacyclin, but not thromboxane. They could, therefore, have a prothrombotic effect (GA
FitzGerald and C Patrono, N Engl J Med 2001; 345:433).
A recent safety study raised concerns that selective COX-2 inhibitors
may increase the risk of thrombotic cardiovascular events. The Vioxx Gastrointestinal Outcomes Research (VIGOR) study randomized 8076 older rheumatoid arthritis patients (average age 58 years) to receive either 50 mg of rofecoxib daily or 500 mg of naproxen twice daily, with a median followup of 9 months (C Bombardier et al, N Engl J Med 2000; 343:1520). This dosage of rofecoxib is 2-4 times the dosage recommended for osteoarthritis. Patients with recent cardiovascular events and those taking aspirin were excluded.
Serious thrombotic cardiovascular events occurred in 45 of 4047 patients (1.11%) taking rofecoxib and in 19 of 4029 (0.47%) taking naproxen. A similar safety study of celecoxib, the Celecoxib Long-term Arthritis Safety Study (CLASS), did not exclude patients taking low-dose aspirin, and no statistically significant increase in cardiovascular events was detected with use of celecoxib 400 mg b.i.d. (4 times the dosage for osteoarthritis) compared to diclofenac (Voltaren) or ibuprofen (Motrin, and others). In general, patients taking celecoxib had about half the incidence of serious gastrointestinal events (perforation, obstruction, bleeding) as those taking diclofenac
or ibuprofen (11 of 1441 vs. 20 of 1384), but those taking aspirin as well had about the same
incidence with celecoxib (6 of 298) as with diclofenac or ibuprofen (6 of 283) (FE Silverstein et
al, JAMA 2000; 284:1247).
One recent review (D Mukherjee et al, JAMA 2001; 286:954) compared annualized myocardial
infarction (MI) rates in patients treated with COX-2 inhibitors in 4 studies (including
CLASS and VIGOR) to historical healthy controls not taking low-dose aspirin and concluded
that both celecoxib and rofecoxib increased risks for MI. Rheumatoid arthritis, which was
EDITOR: Mark Abramowicz, M.D. DEPUTY EDITOR: Gianna Zuccotti, M.D., M.P.H., Weill Medical College of Cornell University
CONSULTING EDITOR: Martin A. Rizack, M.D., Ph.D., Rockefeller University ASSOCIATE EDITORS: Donna Goodstein, Amy Faucard ASSISTANT EDITOR: Susie Wong
CONTRIBUTING EDITORS: Philip D. Hansten, Pharm. D., University of Washington; Neal H. Steigbigel, M.D., New York University School of Medicine
ADVISORY BOARD: William T. Beaver, M.D., Georgetown University School of Medicine; Jules Hirsch, M.D., Rockefeller University; James D. Kenney, M.D., Yale University
School of Medicine; Gerhard Levy, Pharm.D., State University of N.Y. at Buffalo; Gerald L. Mandell, M.D., University of Virginia School of Medicine; Hans Meinertz, M.D.,
University Hospital, Copenhagen; Dan M. Roden, M.D., Vanderbilt School of Medicine; F. Estelle R. Simons, M.D., University of Manitoba
EDITORIAL FELLOWS: Elizabeth Stephens, M.D., Oregon Health Sciences University School of Medicine; Arthur M.F. Yee, M.D., Ph.D., Cornell University Medical Center
EDITORIAL ADMINISTRATOR: Marianne Aschenbrenner PUBLISHER: Doris Peter, Ph.D.
Founded 1959 by Arthur Kallet and Harold Aaron, M.D. Copyright 2002. (ISSN 1523-2859)
FORWARDING OR COPYING IS A VIOLATION OF U.S. AND INTERNATIONAL COPYRIGHT LAWS 99
common among the patients in the CLASS and VIGOR studies, but not among the historical
controls, has been associated with an increased risk of cardiovascular disease (S Wållberg-
Jonsson et al, J Rheumatol 1997; 24:445). A second recent review of 23 studies found no evidence
of an excess of cardiovascular events with rofecoxib compared to various NSAIDs or
placebo (MA Konstam et al, Circulation, November 6, 2001; 104:2280).
CONCLUSION — In one study, high doses of rofecoxib taken for months were associated
with a 1.11% incidence of thrombotic cardiovascular events compared to 0.47% with naproxen.
Taking aspirin with a selective COX-2 inhibitor could protect against any possible
prothrombotic effect, but would probably also diminish the apparent advantage in gastrointestinal
safety with these drugs. Until more prospective studies with and without low-dose aspirin
are available, it would be premature to conclude that rofecoxib or celecoxib increase the
risk of thrombotic cardiovascular disease.
THE MEDICAL LETTER (ISSN 1523-2859) is published and printed in the USA bi-weekly by The Medical Letter, Inc., a non-profit corporation. Second-class postage
paid at New Rochelle, NY, and at additional mailing offices. POSTMASTER: Send address changes to THE MEDICAL LETTER at 1000 Main Street, New Rochelle, NY
10801-7537. Subscription fees: 1 year, $55.00; 2 years, $94.00; 3 years, $132.00 ($27.50—U.S. Funds—per year for individual subscriptions to students, interns,
residents, and fellows in the USA and Canada; special fees for bulk orders). Major credit cards accepted. Copyright and Disclaimer: Subscriptions are accepted with
the understanding that no part of the material may be reproduced or transmitted by any process in whole or in part without prior permission in writing. The editors
and publisher do not warrant that all the material in this publication is accurate and complete in every respect. The editors and publisher shall not be held responsiblefor any damage resulting from any error, inaccuracy or omission.
Phone: 1-800-211-2769 Fax: 1-914-632-1733 WEB SITE: http://www.medletter.com
100 The Medical Letter • Vol. 43 (Issue W1118A) November 12, 2001
Vioxx Lawsuit
they may increase the risk of thrombotic cardiovascular events.
Most older nonsteroidal anti-inflammatory drugs (NSAIDs)
decrease endothelial production of both thromboxane, which has a prothrombotic effect on platelets, and prostacyclin, which has an antithrombotic effect. The usual net effect is some inhibition of platelet function and prolongation of bleeding time. Platelet inhibition is reversible when the drug is cleared, except with aspirin, which has an antiplatelet effect for the life of the platelet, an average of about 7 days. Selective COX-2 inhibitors decrease production of prostacyclin, but not thromboxane. They could, therefore, have a prothrombotic effect (GA
FitzGerald and C Patrono, N Engl J Med 2001; 345:433).
A recent safety study raised concerns that selective COX-2 inhibitors
may increase the risk of thrombotic cardiovascular events. The Vioxx Gastrointestinal Outcomes Research (VIGOR) study randomized 8076 older rheumatoid arthritis patients (average age 58 years) to receive either 50 mg of rofecoxib daily or 500 mg of naproxen twice daily, with a median followup of 9 months (C Bombardier et al, N Engl J Med 2000; 343:1520). This dosage of rofecoxib is 2-4 times the dosage recommended for osteoarthritis. Patients with recent cardiovascular events and those taking aspirin were excluded.
Serious thrombotic cardiovascular events occurred in 45 of 4047 patients (1.11%) taking rofecoxib and in 19 of 4029 (0.47%) taking naproxen. A similar safety study of celecoxib, the Celecoxib Long-term Arthritis Safety Study (CLASS), did not exclude patients taking low-dose aspirin, and no statistically significant increase in cardiovascular events was detected with use of celecoxib 400 mg b.i.d. (4 times the dosage for osteoarthritis) compared to diclofenac (Voltaren) or ibuprofen (Motrin, and others). In general, patients taking celecoxib had about half the incidence of serious gastrointestinal events (perforation, obstruction, bleeding) as those taking diclofenac
or ibuprofen (11 of 1441 vs. 20 of 1384), but those taking aspirin as well had about the same
incidence with celecoxib (6 of 298) as with diclofenac or ibuprofen (6 of 283) (FE Silverstein et
al, JAMA 2000; 284:1247).
One recent review (D Mukherjee et al, JAMA 2001; 286:954) compared annualized myocardial
infarction (MI) rates in patients treated with COX-2 inhibitors in 4 studies (including
CLASS and VIGOR) to historical healthy controls not taking low-dose aspirin and concluded
that both celecoxib and rofecoxib increased risks for MI. Rheumatoid arthritis, which was
EDITOR: Mark Abramowicz, M.D. DEPUTY EDITOR: Gianna Zuccotti, M.D., M.P.H., Weill Medical College of Cornell University
CONSULTING EDITOR: Martin A. Rizack, M.D., Ph.D., Rockefeller University ASSOCIATE EDITORS: Donna Goodstein, Amy Faucard ASSISTANT EDITOR: Susie Wong
CONTRIBUTING EDITORS: Philip D. Hansten, Pharm. D., University of Washington; Neal H. Steigbigel, M.D., New York University School of Medicine
ADVISORY BOARD: William T. Beaver, M.D., Georgetown University School of Medicine; Jules Hirsch, M.D., Rockefeller University; James D. Kenney, M.D., Yale University
School of Medicine; Gerhard Levy, Pharm.D., State University of N.Y. at Buffalo; Gerald L. Mandell, M.D., University of Virginia School of Medicine; Hans Meinertz, M.D.,
University Hospital, Copenhagen; Dan M. Roden, M.D., Vanderbilt School of Medicine; F. Estelle R. Simons, M.D., University of Manitoba
EDITORIAL FELLOWS: Elizabeth Stephens, M.D., Oregon Health Sciences University School of Medicine; Arthur M.F. Yee, M.D., Ph.D., Cornell University Medical Center
EDITORIAL ADMINISTRATOR: Marianne Aschenbrenner PUBLISHER: Doris Peter, Ph.D.
Founded 1959 by Arthur Kallet and Harold Aaron, M.D. Copyright 2002. (ISSN 1523-2859)
FORWARDING OR COPYING IS A VIOLATION OF U.S. AND INTERNATIONAL COPYRIGHT LAWS 99
common among the patients in the CLASS and VIGOR studies, but not among the historical
controls, has been associated with an increased risk of cardiovascular disease (S Wållberg-
Jonsson et al, J Rheumatol 1997; 24:445). A second recent review of 23 studies found no evidence
of an excess of cardiovascular events with rofecoxib compared to various NSAIDs or
placebo (MA Konstam et al, Circulation, November 6, 2001; 104:2280).
CONCLUSION — In one study, high doses of rofecoxib taken for months were associated
with a 1.11% incidence of thrombotic cardiovascular events compared to 0.47% with naproxen.
Taking aspirin with a selective COX-2 inhibitor could protect against any possible
prothrombotic effect, but would probably also diminish the apparent advantage in gastrointestinal
safety with these drugs. Until more prospective studies with and without low-dose aspirin
are available, it would be premature to conclude that rofecoxib or celecoxib increase the
risk of thrombotic cardiovascular disease.
THE MEDICAL LETTER (ISSN 1523-2859) is published and printed in the USA bi-weekly by The Medical Letter, Inc., a non-profit corporation. Second-class postage
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100 The Medical Letter • Vol. 43 (Issue W1118A) November 12, 2001
Vioxx Lawsuit
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