Key Points
- To determine whether celecoxib or ibuprofen interferes with aspirin-induced platelet COX-1 inhibition in patients with osteoarthritis and stable ischemic heart disease.
- Placebo-controlled, randomized study of 24 patients receiving long-term cardioprotective aspirin (100 mg daily).
- Patients were coadministered celecoxib (200 mg twice daily), ibuprofen (600 mg 3 times daily), or placebo for 7 days.
- Celecoxib or placebo coadministration did not attenuate aspirin-mediated COX-1 inhibition, whereas ibuprofen caused a significant increase in serum TXB2 from baseline median 1.65 ng/mL (range, 0.55-79.8 ng/mL) to 19.13 ng/mL at day 7 pre-dose and 22.28 ng/mL at 24 hours post-dose (P < .001).
- Ibuprofen was associated with significant increases in arachidonic acid-induced (P < .01) and ADP-induced (P < .05) platelet aggregation, alongside a reduced occlusive thrombus formation time (P < .01).
- Persistent ex vivo COX-2 inhibition was achieved by both ibuprofen (≥80%) and celecoxib (≥70%), whereas systemic thromboxane excretion was not significantly altered by either drug.
Structured PICO
Does celecoxib or ibuprofen undermine the antiplatelet effect of aspirin in patients with osteoarthritis and stable ischemic heart disease?
PPopulation24 patients with osteoarthritis and stable ischemic heart disease undergoing long-term treatment with aspirin (100 mg daily) for cardioprotection
IInterventionCelecoxib 200 mg twice daily or ibuprofen 600 mg 3 times daily coadministered with aspirin for 7 days
CComparatorPlacebo coadministered with aspirin for 7 days
OOutcomeInhibition of platelet COX-1 activity by aspirin, assessed by serum thromboxane B(2) (TXB(2)) levels and platelet functionsurrogate
Ibuprofen, but not celecoxib, interferes with the antiplatelet effect of aspirin in patients with stable ischemic heart disease, suggesting celecoxib may be a safer NSAID choice in this population.