Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, 22042, USA.
Platelet and Thrombosis Research, LLC, Lutherville, MD, USA.
J Thromb Thrombolysis. 2019 Jan;47(1):16-30. doi: 10.1007/s11239-018-1764-5.
The concomitant use of low-dose aspirin for cardioprotection and non-steroidal anti-inflammatory agents for pain relief is prevalent, particularly in the elderly for whom cardiovascular disease and pain are common co-morbidities. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are known to interfere with the antiplatelet effect of aspirin through competitive binding with COX-1. While the clinical significance of this interference is still unclear, this review sought to assess the body of literature which has evaluated the potential attenuation of the anti-platelet effect of aspirin when dosed concomitantly with an NSAID. This review supports that the pharmacodynamic interaction between aspirin and non-selective NSAIDs occurs, but finds that the interaction varies amongst agents, and is highly dependent on numerous factors including: dose timing, dose of aspirin, and dose of the NSAID in question. Recent findings suggest that patient factors, such as body weight may also be indicators of aspirin's cardiovascular effectiveness. Ultimately, the clinical decision making for concomitant NSAID and low-dose aspirin regimens remains at the patient level.
低剂量阿司匹林用于心脏保护，以及非甾体抗炎药用于缓解疼痛的联合使用较为普遍，尤其是在患有常见合并症（心血管疾病和疼痛）的老年人中。众所周知，非选择性非甾体抗炎药（NSAIDs）通过与 COX-1 的竞争性结合来干扰阿司匹林的抗血小板作用。虽然这种干扰的临床意义尚不清楚，但本综述旨在评估评估同时使用 NSAID 时阿司匹林抗血小板作用潜在减弱的文献。本综述支持阿司匹林和非选择性 NSAIDs 之间存在药效学相互作用，但发现相互作用在不同药物之间存在差异，并且高度依赖于许多因素，包括：剂量时间、阿司匹林剂量和所讨论的 NSAID 剂量。最近的研究结果表明，患者因素，如体重，也可能是阿司匹林心血管有效性的指标。最终，同时使用 NSAID 和低剂量阿司匹林方案的临床决策仍然取决于患者个体情况。
