A narrative review of the cardiovascular risks associated with concomitant aspirin and NSAID use
- 303 Downloads
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.
KeywordsAspirin Non-steroidal anti-inflammatory drugs Cyclooxygenase-1 Cardiovascular disease
Compliance with ethical standards
Dr. Gurbel reports receiving grants from the National Institutes of Health, Bayer, Medicure, Instrumentation labs, USWorldMeds, Haemonetics, Amgen, Idorsia, Ionis, Janssen, and Merck; receiving honoraria and payment for lectures, consultations including service on speakers’ bureaus from Bayer, Janssen, Merck, UptoDate, and Medicure; and holding patents in the area of personalized antiplatelet therapy and interventional cardiology. Dr. Tantry reports receiving honoraria from Medicure, AstraZeneca and Upto Date. Dr. Weisman is a consultant to Bayer.
- 3.Smith SC Jr et al (2011) AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 124:2458–2473CrossRefGoogle Scholar
- 7.FDA Information for Healthcare Professionals (2006) Concomitant use of ibuprofen and aspirin new information. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm. Accessed 12 Aug 2018
- 16.Vane JR (1971) Inhibition of prostaglandin synthesis as a mechanism of action for the aspirin-like drugs. Nature 231:232–235Google Scholar
- 25.Goodman LS, Gilman A (eds) (2011) Anti-inflammatory, antipyretic, and analgesic agents; pharmacotherapy of gout. In: The pharmacological basis of therapeutics, 12th edn. Pergamon Press, New YorkGoogle Scholar
- 35.Reilly IA, FitzGerald GA (1987) Inhibition of thromboxane formation in vivo and ex vivo: implications for therapy with platelet inhibitory drugs. Blood 69:180–186Google Scholar
- 37.Solomon D. NSAIDS (2013) Mechanism of action 2. http://www.uptodate.com/contents/nsaidsmechanism-of-action. Accessed on 10 Aug 2018
- 47.Angiolillo DJ, Desai B, Hwang C et al (2011) Impact of a fixed-dose combination of naproxen and esomeprazole magnesium on serum thromboxane b2 inhibition by low-dose aspirin over 5 days in healthy adults: a phase I, randomized, double-blind, placebo-controlled, non-inferiority trial. Clin Ther 33:1883–1893CrossRefGoogle Scholar
- 55.Hudson M, Baron M, Rahme E et al (2005) Ibuprofen may abrogate the benefits of aspirin when used for secondary prevention of myocardial infarction. J Rheumatol 32:1589–1593Google Scholar
- 56.Reed GW, Abdallah M, Shao M et al ( 2017) Effect of aspirin on the cardiovascular, gastrointestinal, and renal safety of celecoxib, naproxen, or ibuprofen. American Heart Association 2017 Scientific Sessions, AnaheimGoogle Scholar