ASPIRIN AND NSAIDS

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.
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