There is some evidence that non-selective
NSAIDs such as
ibuprofen antagonise the antiplatelet effects of low-dose
aspirin but that coxibs do not. However, some
NSAIDs (particularly coxibs) are also associated with an increased thrombotic/cardiovascular risk. Some epidemiological studies have shown that non-selective
NSAIDs reduce the cardioprotective effects of low-dose
aspirin. Combined use of
NSAIDs (including coxibs) and aspirin, even in low-dose, increases the risk of
gastrointestinal bleeds.
The evidence suggesting antagonism of antiplatelet effects is currently insufficient to recommend a change in practice. The CSM in the UK has advised that the combination of a non-aspirin
NSAID and low-dose
aspirin should be used only if absolutely necessary, and patients taking long-term
aspirin should be reminded to avoid NSAIDs, including those bought without prescription. If antiplatelet dose
aspirin is used with NSAIDs, gastroprotection (e.g. a PPI) should be considered, especially when other risk factors (e.g. corticosteroids) are present. There is no
clinical rationale for the combined use of anti-inflammatory/analgesic doses of
aspirin and NSAIDs, and such use should be avoided.