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Previous Volume 345:1809-1817 December 20, 2001 Number 25 Next

	Full Text PDF Editorial by Crofford, L. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Patients with arthritis and vascular disease may receive both low-dose aspirin and other nonsteroidal antiinflammatory drugs. We therefore investigated potential interactions between aspirin and commonly prescribed arthritis therapies.

Methods We administered the following combinations of drugs for six days: aspirin (81 mg every morning) two hours before ibuprofen (400 mg every morning) and the same medications in the reverse order; aspirin two hours before acetaminophen (1000 mg every morning) and the same medications in the reverse order; aspirin two hours before the cyclooxygenase-2 inhibitor rofecoxib (25 mg every morning) and the same medications in the reverse order; enteric-coated aspirin two hours before ibuprofen (400 mg three times a day); and enteric-coated aspirin two hours before delayed-release diclofenac (75 mg twice daily).

Results Serum thromboxane B₂ levels (an index of cyclooxygenase-1 activity in platelets) and platelet aggregation were maximally inhibited 24 hours after the administration of aspirin on day 6 in the subjects who took aspirin before a single daily dose of any other drug, as well as in those who took rofecoxib or acetaminophen before taking aspirin. In contrast, inhibition of serum thromboxane B₂ formation and platelet aggregation by aspirin was blocked when a single daily dose of ibuprofen was given before aspirin, as well as when multiple daily doses of ibuprofen were given. The concomitant administration of rofecoxib, acetaminophen, or diclofenac did not affect the pharmacodynamics of aspirin.

Conclusions The concomitant administration of ibuprofen but not rofecoxib, acetaminophen, or diclofenac antagonizes the irreversible platelet inhibition induced by aspirin. Treatment with ibuprofen in patients with increased cardiovascular risk may limit the cardioprotective effects of aspirin.

Source Information

From the EUPenn Group of Investigators at the Center for Experimental Therapeutics (F.C.-L., S.D., B.T., G.A.F.), the Division of Cardiology (M.P.R.), and the General Clinical Research Center (F.C.-L., S.C.K., A.J.C., S.N.V., G.A.F.), University of Pennsylvania School of Medicine, Philadelphia.

Address reprint requests to Dr. FitzGerald at the University of Pennsylvania School of Medicine, 153 Johnson Pavilion, 3620 Hamilton Walk, Philadelphia, PA 19104-6084, or at garret{at}spirit.gcrc.upenn.edu.

Full Text of this Article

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Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin
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Extract | Full Text | PDF  
N Engl J Med 2002; 346:1589-1590, May 16, 2002. Correspondence

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