Potential contribution of long-term rofecoxib in a patient with cardiogenic syncope and ischemic stroke

Objective: To report a case of syncope followed by a cerebrovascular event in a patient receiving long-term therapy with rofecoxib. Case Summary: A 62-year-old man presented to a local rural hospital emergency department with loss of motor control in his left extremities. Neurologic workup confirmed a right hemispheric cerebrovascular accident. Carotid arteries were noncontributory, and cardiac workup was unrevealing except for thoracic aorta atherosclerosis. There was no history of hypertension, coronary artery disease, diabetes mellitus, left ventricular systolic dysfunction, or valvular stenotic disease. Cardiovascular risk factors included smoking and dyslipidemia with low high-density lipoprotein cholesterol and hypertriglyceridemia. Of importance was the patient's 4 year history of rofecoxib use, 25 mg daily for a chronic back injury. Discussion: Recently published reports suggest that rofecoxib can contribute significantly to increased cerebrovascular events by an approximately twofold elevation in relative risk. An adverse drug reaction assessment, using the Naranjo probability scale, indicated a possible relationship of rofecoxib to the events. Rofecoxib was discontinued. Conclusions: Recent evidence of additive cardiovascular risk conveyed by cyclooxygenase-2 inhibitors and the temporal relationship between rofecoxib use and cerebrovascular events suggests that rofecoxib may be a potentially contributing factor to the unfavorable outcomes in our patient.