Low-dose aspirin reduces gastro-protective properties of COX-2 selective inhibitors

We present the case of a patient taking aspirin and etoricoxib who was admitted with upper digestive haemorrhage due to duodenal ulcer. With this case we emphasize that the potential of the stomach-protecting properties of COX-2 selective inhibitors may be reduced in patients who are simultaneously taking aspirin. We also review several pathogenic mechanisms that have been advanced by animal studies to explain the finding that a COX-2 selective inhibitor plus low-dose aspirin leads to an ulcer rate near that of a dual COX-1/COX-2 inhibitor alone.