The Pharmaceutical Journal
Vol 270 No 7236 p217
15 February 2003

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The Lancet (www.thelancet.com)

Ibuprofen's inhibition of aspirin protection leads to patients' deaths

Research showing that ibuprofen leads to inhibition of aspirin's cardioprotective effects has been borne out by new mortality data.

Last year, scientists showed that ibuprofen blocked aspirin's inhibition of platelet aggregation (PJ, 5/12 January 2002, p5). Now, researchers from the medicines monitoring unit at Ninewells Hospital, Dundee, have shown increased mortality in patients with cardiovascular disease who use this combination. Professor Tom MacDonald and Li Wei studied over 7,000 patients with coronary heart disease discharged from hospital and prescribed low-dose aspirin.

Compared with those who used aspirin alone, those prescribed concomitant ibuprofen had around double the risk of all cause mortality (hazard ratio 1.93, 95 per cent confidence interval 1.30–2.87, P=0.0011). There was around a 75 per cent increase in risk of cardiovascular mortality.

There was no increase in mortality risk for people prescribed aspirin with diclofenac or other non-steroidal anti-inflammatory drugs (Lancet 2003;361:573).

The authors comment that, although their findings are not conclusive, "they lend support to the hypothesis that treatment with a combination of ibuprofen and aspirin given for secondary prevention may be deleterious, possibly by antagonising the cardioprotective effects of aspirin".

Professor MacDonald said: "Perhaps it would be prudent that such patients took an alternative painkiller at least until this issue is further clarified."