Antiplatelet Effects of Aspirin: Which NSAIDs Interact?


May 2013

John R. Horn, PharmD, FCCP and Philip D. Hansten, PharmD





1. Hohlfeld T, et al. High on treatment platelet reactivity against aspirin by non-steroidal anti-inflammatory drugs—pharmacological mechanisms and clinical relevance. Thromb Haemost. 2013;109: doi:10.1160/TH12-07-532

2. Catella-Lawson F, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345:1809-1817.

3. Meek IL, et al. Interference of NSAIDs with the thrombocyte inhibitory effect of aspirin: a placebo-controlled, ex vivo, serial placebo-controlled serial crossover study. Eur J Clin Pharmacol. 2012;DOI 10.1007/s00228-012-1370-y.

4. Gladding PA, et al. The antiplatelet effect of six non-steroidal anti-inflammatory drugs and their pharmacodynamic interaction with aspirin in healthy volunteers. Am J Cardiol. 2008;101:1060-1063.

5. Capone MI, et al. Pharmacodynamic interaction of naproxen with low-dose aspirin in healthy subjects. JACC 2005:45:1295-1301.

6. Anzellotti P, et al. Low-dose naproxen interferes with the antiplatlet effects of aspirin in healthy subjects: recommendations to minimize the functional consequences. Arthritis Thrum. 2011;63:850-859.

7. Livio M, et al. Indomethacin prevents the long-lasting effects of aspirin on human platelet cyclo-oxygenase activity. Prostaglandins. 1982;23:787-796.

8. Gengo FM, et al. Effects of ibuprofen on the magnitude and duration of aspirin’s inhibition of platelet aggregation: clinical consequences in stroke prophylaxis. J Clin Pharmacol. 2008;48:117-122.

9. Rimon G et al. Coxibs interfere with the action of aspirin by binding tightly to one monomer of cyclooxygenase-1. Proc Natl Acad Sci USA. 2009;107:28-33.

10. Farkouh ME, et al. Cardiovascular outcomes in high risk patients with osteoarthritis treated with ibuprofen, naproxen or lumiracoxib. Ann Rheum Dis. 2007;66:764-770.

11. Kimmel SE, et al. The effects of nonselective non-aspirin non-steroidal anti-inflammatory medications on the risk of nonfatal myocardial infarction and their interaction with aspirin. J AM Coll Cardiol. 2004;43:985-990.

12. Ridker PM, et al. Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial. Ann Intern Med. 1991;114:835-839.

13. MacDonald TM, Wei L. Effect of ibuprofen on cardioprotective effect of aspirin. Lancet. 2003;361:573-574.

14. Hennekens CH, et al. Hypothesis formulation from subgroup analyses: nonadherence or nonsteroidal anti-inflammatory drug use explains the lack of clinical benefit of aspirin on first myocardial infarction attributed to “aspirin resistance.” Am Heart J. 2010;159:744-748.

15. Fischer LM, et al. Current use of nonsteroidal anti-inflammatory drugs and the risk of acute myocardial infarction. Pharmacotherapy. 2005;25:503-510.

16. Garcia Rodriguez LA, et al. Nonsteroidal antiinflammatory drugs and the risk of myocardial infarction in the general population. Circulation. 2004;109:3000-3006.