Flipo René-Marc
Service de Rhumatologie, CHU Roger Salengro, Lille 59000.
Presse Med. 2006 Sep;35(9 Spec No 1):1S53-60.
Some studies have recently suggested a potential pharmacodynamic interaction between aspirin and some non-selective non-steroidal anti-inflammatory drugs (NSAIDs). We have evaluated the reality of this pharmacodynamic interaction and analyse its clinical pertinence.
Literature review (Medline search - December 2005).
Several ex vivo studies show that some non-selective NSAIDs can block the active site of Cox1 thus preventing aspirin from exerting its platelet anti-aggregating cardio-preventive action. Cox2 selective molecules do not act at this site. The few studies, mainly case reports, have analysed the potential loss of the cardiovascular preventive benefit of aspirin in patients receiving concomitantly non-selective anti-inflammatory drugs with controversial results.
It seems necessary to know the existence of this pharmacodynamic interaction between aspirin at a low dose and some non-selective anti-inflammatory drugs notably ibuprofen and naproxen. In the absence of a clear clinical demonstration, it is advisable to avoid the non-selective NSAIDs in patients treated with a low dose of aspirin. It might be advisable to switch to an anti-aggregating treatment other than aspirin (clopidrogel, etc.) in these cases. At the present time, however, there are no data on which to base such a recommendation.
近期一些研究提示阿司匹林与某些非选择性非甾体抗炎药（NSAIDs）之间可能存在药效学相互作用。我们评估了这种药效学相互作用的实际情况并分析其临床相关性。
文献综述（检索Medline - 2005年12月）。
多项体外研究表明，某些非选择性NSAIDs可阻断Cox1的活性位点，从而阻止阿司匹林发挥其抗血小板聚集的心脏预防作用。Cox2选择性分子不会作用于该位点。少数研究（主要是病例报告）分析了同时接受非选择性抗炎药的患者中阿司匹林心血管预防益处可能丧失的情况，结果存在争议。
似乎有必要了解低剂量阿司匹林与某些非选择性抗炎药（尤其是布洛芬和萘普生）之间这种药效学相互作用的存在。在缺乏明确临床证据的情况下，对于接受低剂量阿司匹林治疗的患者，建议避免使用非选择性NSAIDs。在这些情况下，可能建议改用阿司匹林以外的抗血小板治疗（氯吡格雷等）。然而，目前尚无数据支持此类建议。
