[Interaction between NSAIDs and acetylsalicylic acid disregarded]
SourceNederlands Tijdschrift voor Geneeskunde, 158, 0, (2014), pp. A7893
Article / Letter to editor
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Nederlands Tijdschrift voor Geneeskunde
SubjectRadboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences
In 2013 the European Medicines Agency declared that diclofenac is contraindicated in patients with arterial thrombotic complications, based on a meta-analysis of randomised controlled trials on the adverse reactions of NSAIDs. The same decision was taken for coxibs some years earlier. The Dutch authorities (CBG/MEB) informed physicians and pharmacists about this decision without taking into account whether these patients were using prophylactic acetylsalicylic acid or not. It has been shown that NSAIDs with high COX-1 affinity like ibuprofen and naproxen cause a pharmacodynamic interaction with the inhibition of thromboxane synthesis by acetylsalicylic acid. This interaction does not occur with relatively COX-2-selective NSAIDs such as coxibs and diclofenac. Therefore, in patients who use acetylsalicylic acid for thromboprophylaxis, contraindicating coxibs or diclofenac is not justified, on the contrary: they are preferable.
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