A Narrative Review of the Cardiovascular Risks Associated with Concomitant Aspirin and NSAID Use

Overview

Journal J Thromb Thrombolysis

Specialty Cardiology & Vascular Diseases

Date 2018 Nov 9

PMID 30406348

Citations 8

Authors

Paul Gurbel

Udaya Tantry

Steven Weisman

Affiliations

Soon will be listed here.

Abstract

The concomitant use of low-dose aspirin for cardioprotection and non-steroidal anti-inflammatory agents for pain relief is prevalent, particularly in the elderly for whom cardiovascular disease and pain are common co-morbidities. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are known to interfere with the antiplatelet effect of aspirin through competitive binding with COX-1. While the clinical significance of this interference is still unclear, this review sought to assess the body of literature which has evaluated the potential attenuation of the anti-platelet effect of aspirin when dosed concomitantly with an NSAID. This review supports that the pharmacodynamic interaction between aspirin and non-selective NSAIDs occurs, but finds that the interaction varies amongst agents, and is highly dependent on numerous factors including: dose timing, dose of aspirin, and dose of the NSAID in question. Recent findings suggest that patient factors, such as body weight may also be indicators of aspirin's cardiovascular effectiveness. Ultimately, the clinical decision making for concomitant NSAID and low-dose aspirin regimens remains at the patient level.

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References

Brown N, May J, Wilcox R, Allan L, Wilson A, Kiff P . Comparison of antiplatelet activity of microencapsulated aspirin 162.5 Mg (Caspac XL), with enteric coated aspirin 75 mg and 150 mg in patients with atherosclerosis. Br J Clin Pharmacol. 1999; 48(1):57-62. PMC: 2014875. DOI: 10.1046/j.1365-2125.1999.00947.x. View

Feldman M, Cryer B . Aspirin absorption rates and platelet inhibition times with 325-mg buffered aspirin tablets (chewed or swallowed intact) and with buffered aspirin solution. Am J Cardiol. 1999; 84(4):404-9. DOI: 10.1016/s0002-9149(99)00324-0. View

Awtry E, Loscalzo J . Aspirin. Circulation. 2000; 101(10):1206-18. DOI: 10.1161/01.cir.101.10.1206. View

Reilly M, Kapoor S, Cucchiara A, Demarco S, Tournier B, Vyas S . Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001; 345(25):1809-17. DOI: 10.1056/NEJMoa003199. View

Van Hecken A, Juliano M, Depre M, De Lepeleire I, Arnout J, Dynder A . Effects of enteric-coated, low-dose aspirin on parameters of platelet function. Aliment Pharmacol Ther. 2002; 16(9):1683-8. DOI: 10.1046/j.1365-2036.2002.01332.x. View

Capone M, Tacconelli S, Sciulli M, Grana M, Ricciotti E, Minuz P . Clinical pharmacology of platelet, monocyte, and vascular cyclooxygenase inhibition by naproxen and low-dose aspirin in healthy subjects. Circulation. 2004; 109(12):1468-71. DOI: 10.1161/01.CIR.0000124715.27937.78. View

Cheema A . Should people on aspirin avoid Ibuprofen? A review of the literature. Cardiol Rev. 2004; 12(3):174-6. DOI: 10.1097/01.crd.0000107892.83612.9d. View

van Ryn J, Kink-Eiband M, Kuritsch I, Feifel U, Hanft G, Wallenstein G . Meloxicam does not affect the antiplatelet effect of aspirin in healthy male and female volunteers. J Clin Pharmacol. 2004; 44(7):777-84. DOI: 10.1177/0091270004266623. View

Cryer B, Berlin R, Cooper S, Hsu C, Wason S . Double-blind, randomized, parallel, placebo-controlled study of ibuprofen effects on thromboxane B2 concentrations in aspirin-treated healthy adult volunteers. Clin Ther. 2005; 27(2):185-91. DOI: 10.1016/j.clinthera.2005.01.011. View

10.

Capone M, Sciulli M, Tacconelli S, Grana M, Ricciotti E, Renda G . Pharmacodynamic interaction of naproxen with low-dose aspirin in healthy subjects. J Am Coll Cardiol. 2005; 45(8):1295-301. DOI: 10.1016/j.jacc.2005.01.045. View

11.

Fischer L, Schlienger R, Matter C, Jick H, Meier C . Current use of nonsteroidal antiinflammatory drugs and the risk of acute myocardial infarction. Pharmacotherapy. 2005; 25(4):503-10. DOI: 10.1592/phco.25.4.503.61021. View

12.

Hudson M, Baron M, Rahme E, Pilote L . Ibuprofen may abrogate the benefits of aspirin when used for secondary prevention of myocardial infarction. J Rheumatol. 2005; 32(8):1589-93. View

13.

Patrono C, Garcia Rodriguez L, Landolfi R, Baigent C . Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med. 2005; 353(22):2373-83. DOI: 10.1056/NEJMra052717. View

14.

Hernandez-Diaz S, Varas-Lorenzo C, Garcia Rodriguez L . Non-steroidal antiinflammatory drugs and the risk of acute myocardial infarction. Basic Clin Pharmacol Toxicol. 2006; 98(3):266-74. DOI: 10.1111/j.1742-7843.2006.pto_302.x. View

15.

Renda G, Tacconelli S, Capone M, Sacchetta D, Santarelli F, Sciulli M . Celecoxib, ibuprofen, and the antiplatelet effect of aspirin in patients with osteoarthritis and ischemic heart disease. Clin Pharmacol Ther. 2006; 80(3):264-74. DOI: 10.1016/j.clpt.2006.05.004. View

16.

Gerardo E Zarraga I, Schwarz E . Coxibs and heart disease: what we have learned and what else we need to know. J Am Coll Cardiol. 2007; 49(1):1-14. DOI: 10.1016/j.jacc.2006.10.003. View

17.

Farkouh M, Greenberg J, Jeger R, Ramanathan K, Verheugt F, Chesebro J . Cardiovascular outcomes in high risk patients with osteoarthritis treated with ibuprofen, naproxen or lumiracoxib. Ann Rheum Dis. 2007; 66(6):764-70. PMC: 1954641. DOI: 10.1136/ard.2006.066001. View

18.

Scheiman J, Fendrick A . Summing the risk of NSAID therapy. Lancet. 2007; 369(9573):1580-1. DOI: 10.1016/S0140-6736(07)60722-3. View

19.

Gurbel P, Bliden K, DiChiara J, Newcomer J, Weng W, Neerchal N . Evaluation of dose-related effects of aspirin on platelet function: results from the Aspirin-Induced Platelet Effect (ASPECT) study. Circulation. 2007; 115(25):3156-64. DOI: 10.1161/CIRCULATIONAHA.106.675587. View

20.

Sopena F, Lanas A . How to advise aspirin use in patients who need NSAIDs. Curr Pharm Des. 2007; 13(22):2248-60. DOI: 10.2174/138161207781368837. View