It has been reported that patients with acute coronary syndrome (ACS) who
were previously on aspirin therapy but had discontinued aspirin use had
worse short-term outcomes than individuals not previously on aspirin therapy
(Collett JP, et al. Circulation 2004; 110:2361-2367). Also, researchers
have reported that discontinuation of aspirin by daily aspirin users may
increase the risk of myocardial infarction. (Fischer LM et al. Arch Intern
Med, 2004, 164: 2472-2476). A Harvard Health Letter (volume 30:6, 2005)
also stated that quitting aspirin "cold turkey" could be dangerous and that
studies have linked aspirin withdrawal with heart attacks. Researchers have
showed that the risk of acute myocardial infarction (AMI) was one and one
half times greater for subjects who stopped taking non-steroidal
anti-inflammatory drugs (NSAIDs) including aspirin from 1 to 29 days
compared to non-users.
The study by Collett et al stated that temporary withdrawal of aspirin is
common and acute rebound effect with coronary thrombosis is a suspected
result of the withdrawal.
ALSO, in a statement released on Sept. 8, 2006 the FDA notified consumers
and health care professionals that the administration of ibuprofen for pain
relief to patient taking aspirin for cardioprotection may interfere with
aspirin's cardiovascular benefits. The FDA states that ibuprofen can
interfere with the antiplatelet effect of low-dose aspirin (81 mg daily).
this could result in diminished effectiveness of aspirin as used for
cardioprotection and stroke prevention.
Recommendations -
1. Patients who use immediate release aspirin (not enteric coated aspirin)
and take a single dose of ibuprofen 400 mg should dose the ibuprofen at
least 30 minutes or longer after aspirin ingestion to avoid attenuation of
aspirin's effect.
2. At this time, recommendations about the timing of ibuprofen 400 mg in
patients taking enteric-coated low dose aspirin cannot be made based on
available data. One study, however, showed that the antiplatelet effect of
enteric-coated low dose aspirin was attenuated when ibuprofen 400 me was
dosed 2, 7, and 12 hours after aspirin (Catella-Lawson et al. NEJM 2001;
345:1809-1817.
3. Acetaminophen appears to not interfere with the antiplatelet effect of
low dose aspirin.
4. Other OTC NSAIDs (naproxen sodium and ketoprofen) should be viewed as
having the potential to interfere with the antiplatelet effect of low-dose
aspirin until proven otherwise. The FDA is unaware of any studies that have
looked at the same type of interfer4rence by ketoprofen with low-dose
aspirin.
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