Ibuprofen could reduce cardioprotective effect of aspirin

A research letter in this week's issue of THE LANCET suggests that the painkiller ibuprofen could diminish the well-known beneficial effects of aspirin on preventing cardiovascular disease.

Aspirin makes platelets (blood-clotting cells) less 'sticky', which is associated with fewer thromboses (clots). Aspirin therefore reduces the chance of heart attacks caused by coronary thrombosis and stroke (cerebral thrombosis). Previous laboratory research has suggested that ibuprofen interacts with aspirin to reduce this 'good' effect of aspirin on platelet stickiness.

Tom MacDonald and Li Wei from the Medicines Monitoring Unit (MEMO) at the University of Dundee, Ninewells Hospital& Medical School, UK, studied 7107 patients with cardiovascular disease who were discharged from hospital and who were taking prescribed low-dose aspirin. Within this group they compared the death rate (from any cause and from cardiovascular causes) of those patients taking prescribed aspirin alone with those taking prescribed aspirin and ibuprofen. They also compared mortality data for patients taking another common painkiller (diclofenac) and those taking any of the other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in addition to aspirin.

Individuals prescribed both aspirin and ibuprofen (187 patients) had about a doubling of risk of death from any cause and around a 75% increased risk of death from cardiovascular disease, compared with those prescribed aspirin alone. There was no increase in mortality risk for people prescribed aspirin in combination with diclofenac or other NSAIDs.

Tom MacDonald comments: "Although our findings are not conclusive, they do support the hypothesis that ibuprofen may reduce the benefits of aspirin in people with cardiovascular disease. Perhaps it would be prudent that such patients took an alternative painkiller at least until this issue is further clarified. Furthermore, we also know that aspirin and ibuprofen taken together increases the risk of bleeding from stomach ulcers. So this combination may not only reduce the benefits of aspirin, but may also increase the risks of side effects."

Contact: Professor Tom MacDonald, Medicines Monitoring Unit, Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK;
T) 44-138-263-2575;
F) 44-138-264-2637;
E) macdonaldtom@memo.dundee.ac.uk

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