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[Interaction between NSAIDs and acetylsalicylic acid disregarded]
E J Vollaard1, C Kramers, J R B J Brouwers
1Sint Maartenskliniek, afd. Klinische Farmacie, Nijmegen.
Nederlands Tijdschrift Voor Geneeskunde
|August 21, 2014
Summary
Diclofenac and coxibs are not contraindicated for patients using acetylsalicylic acid for thromboprophylaxis. These NSAIDs do not interact with aspirin, making them safer choices for cardiovascular protection.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
Background:
- European Medicines Agency contraindication of diclofenac for arterial thrombotic complications in 2013.
- Similar contraindications for coxibs were established earlier.
- Dutch authorities' communication did not differentiate based on concomitant acetylsalicylic acid use.
Purpose of the Study:
- To evaluate the contraindication of diclofenac and coxibs in patients using acetylsalicylic acid for thromboprophylaxis.
- To clarify the pharmacodynamic interactions between NSAIDs and acetylsalicylic acid.
Main Methods:
- Review of meta-analyses on NSAID adverse reactions.
- Analysis of pharmacodynamic interactions based on COX-1 and COX-2 affinity.
- Assessment of clinical guidelines and drug safety communications.
Main Results:
- NSAIDs with high COX-1 affinity (e.g., ibuprofen, naproxen) interact with acetylsalicylic acid's inhibition of thromboxane synthesis.
- COX-2 selective NSAIDs like coxibs and diclofenac do not exhibit this pharmacodynamic interaction.
- The contraindication for diclofenac and coxibs is not justified in patients on prophylactic acetylsalicylic acid.
Conclusions:
- Diclofenac and coxibs are pharmacodynamically compatible with acetylsalicylic acid.
- These NSAIDs may be preferable to high COX-1 affinity NSAIDs in patients requiring thromboprophylaxis.
- Current contraindications may not be clinically justified for specific patient populations.
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