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at time of writing, Drug Information Specialty Resident and Adjunct Instructor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh; now, Drug Information Pharmacist, Drug Information Center; Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
at time of writing, Drug Information Specialist, Drug Information Center; Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh; now, Drug Utilization Pharmacy Specialist, Rite Aid Corporation Pharmacy Health Services, Coraopolis, PA
at time of writing, Associate Director, Drug Information Center; Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh; now, Clinical Education Consultant, Pfizer, Inc., Pittsburgh, PA; Adjunct Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh
Reprints: Dr. Corman, 302 Scaife Hall, 200 Lothrop St., Pittsburgh, PA 15213-2500, cormansl{at}upmc.edu
OBJECTIVE: To examine the evidence of a pharmacodynamic interaction between aspirin and nonsteroidal antiinflammatory drugs (NSAIDs); specifically, to determine whether a deleterious relationship exists with respect to the cardioprotective effects of aspirin.
DATA SOURCES: Primary articles were identified by a MEDLINE search (1966-May 2004). Search terms included aspirin, nonsteroidal antiinflammatory drug, drug interaction, mortality, myocardial infarction, and stroke.
STUDY SELECTION AND DATA EXTRACTION: All prospective and retrospective studies conducted in human subjects and investigating the potential interaction between aspirin and NSAIDs were included.
DATA SYNTHESIS: Several controlled pharmacodynamic studies indicate that the sustained inhibition of cyclooxygenase activity by aspirin is blunted in the presence of some NSAIDs. While these data are fairly consistent, they are limited in that they rely on surrogate markers and not clinical outcomes. Observational studies have shown conflicting results regarding the effect of combination NSAID and aspirin therapy on mortality risk and incidence of myocardial infarction.
CONCLUSIONS: Pharmacodynamic data indicating an interaction between aspirin and NSAIDs have not translated to a consistent clinical effect in observational studies. In the absence of a randomized, controlled, clinical outcomes study, there is insufficient evidence to dictate a change in therapy.
Key Words: aspirin, mortality, myocardial infarction, NSAIDs
Published Online, May 3, 2005. www.theannals.com, DOI 10.1345/aph.1E514
THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-019-H01
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