Cyclooxygenase inhibitors and the antiplatelet effects of aspirin.
Cyclooxygenase inhibitors and the antiplatelet effects of aspirin.
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DOI：
10.1056/nejmoa003199
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发表时间：
2001-12-20
影响因子：
158.5
通讯作者：
FitzGerald, GA
中科院分区：
文献类型：
--
作者：
Catella-Lawson, F;Reilly, MP;FitzGerald, GA
背景：患有关节炎和血管疾病的患者可以同时服用低剂量阿司匹林和其他非甾体类抗炎药。因此，我们调查了阿司匹林和常用关节炎治疗之间的潜在相互作用。方法：连续6天给予以下药物组合：阿司匹林（每天早晨81毫克）在布洛芬（每天早晨400毫克）之前2小时，相同的药物顺序相反；对乙酰氨基酚服用前两小时服用阿司匹林（每天早晨1000毫克），同样的药物服用顺序相反；服用环氧化酶-2抑制剂罗非昔布前2小时服用阿司匹林（每天早上25毫克），并按相反的顺序服用相同的药物；布洛芬前2小时肠溶阿司匹林（400毫克，一天3次）；在缓释双氯芬酸前2小时肠溶阿司匹林（75毫克，每日2次）。结果：血清血栓素B（亚2）水平（血小板环氧化酶-1活性指标）和血小板聚集在服用阿司匹林第6天24小时后受到最大抑制，在服用阿司匹林之前服用阿司匹林的受试者，以及在服用阿司匹林之前服用罗非昔布或对乙酰氨基酚的受试者。相比之下，阿司匹林对血清血栓素B（sub - 2）形成和血小板聚集的抑制作用，在服用阿司匹林之前服用单剂量布洛芬和服用多剂量布洛芬时均被阻断。同时给予罗非昔布、对乙酰氨基酚或双氯芬酸不影响阿司匹林的药效学。结论：布洛芬而非罗非昔布、对乙酰氨基酚或双氯芬酸可拮抗阿司匹林诱导的不可逆血小板抑制。用布洛芬治疗心血管风险增加的患者可能会限制阿司匹林的心脏保护作用。[J] .中华医学杂志，2001;35(5):1809-17。版权所有(C) 2001马萨诸塞州医学协会。
Background: Patients with arthritis and vascular disease may receive both low-dose aspirin and other nonsteroidal antiinflammatory drugs. We therefore investigated potential interactions between aspirin and commonly prescribed arthritis therapies.Methods: We administered the following combinations of drugs for six days: aspirin (81 mg every morning) two hours before ibuprofen (400 mg every morning) and the same medications in the reverse order; aspirin two hours before acetaminophen (1000 mg every morning) and the same medications in the reverse order; aspirin two hours before the cyclooxygenase-2 inhibitor rofecoxib (25 mg every morning) and the same medications in the reverse order; enteric-coated aspirin two hours before ibuprofen (400 mg three times a day); and enteric-coated aspirin two hours before delayed-release diclofenac (75 mg twice daily).Results: Serum thromboxane B(sub 2) levels (an index of cyclooxygenase-1 activity in platelets) and platelet aggregation were maximally inhibited 24 hours after the administration of aspirin on day 6 in the subjects who took aspirin before a single daily dose of any other drug, as well as in those who took rofecoxib or acetaminophen before taking aspirin. In contrast, inhibition of serum thromboxane B(sub 2) formation and platelet aggregation by aspirin was blocked when a single daily dose of ibuprofen was given before aspirin, as well as when multiple daily doses of ibuprofen were given. The concomitant administration of rofecoxib, acetaminophen, or diclofenac did not affect the pharmacodynamics of aspirin.Conclusions: The concomitant administration of ibuprofen but not rofecoxib, acetaminophen, or diclofenac antagonizes the irreversible platelet inhibition induced by aspirin. Treatment with ibuprofen in patients with increased cardiovascular risk may limit the cardioprotective effects of aspirin. (N Engl J Med 2001;345:1809-17.) Copyright (C) 2001 Massachusetts Medical Society.