Dose reduction, oral application, and order of intake to preserve aspirin antiplatelet effects in dipyrone co-medicated chronic artery disease patients

Dannenberg, Lisa; Petzold, Tobias; Achilles, Alina; Naguib, David; Zako, Saif; Helten, Carolin; M'Pembele, Rene; Mourikis, Philipp; Podsvyadek, Yanina; Grandoch, Maria; Levkau, Bodo; Zeus, Tobias; Kelm, Malte; Hohlfeld, Thomas und Polzin, Amin (2019): Dose reduction, oral application, and order of intake to preserve aspirin antiplatelet effects in dipyrone co-medicated chronic artery disease patients. In: European Journal of Clinical Pharmacology, Bd. 75, Nr. 1: S. 13-20

Abstract

BackgroundDipyrone comedication in aspirin-treated patients is associated with impaired pharmacodynamic response to aspirin (high on-treatment platelet reactivity [HTPR]). Additionally, in small observational studies, an association with impaired outcome has been described. In this uncontrolled, hypothesis-generating study, we aimed to investigate strategies to prevent this drug-drug interaction in patients with coronary artery disease (CAD).MethodsWe analyzed pharmacodynamic response to aspirin in 80 dipyrone co-medicated CAD patients. Aspirin antiplatelet effects were measured using arachidonic acid (AA)-induced light-transmission aggregometry (LTA). Platelet reactivity was associated with daily dose, administration form, and frequency. Additionally, we conducted a time-series analysis in patients with HTPR to aspirin with re-evaluation of pharmacodynamic response to aspirin after 5days.ResultsPatients' mean age was 75.59.8years. Forty-three (54%) were male, 22 (27.5%) obese, and 38 (47.5%) diabetics. Baseline characteristics, cardiovascular risk factors, comorbidities, comedication, or laboratory parameters did not differ between patients with or without HTPR. HTPR to aspirin occurred in 34 out of 80 patients (42.5%). The incidence of HTPR was associated with dipyrone daily dose (<1g/day: HTPR 20% vs. >3g/day: HTPR 50%, p>0.0001) and form of administration (i.v. 87.5% vs. oral 37.5%;p<0.0001). A strict order of intake (aspirin 30min prior to dipyrone) restored aspirin antiplatelet effects in all patients (HTPR before 100% vs. HTPR after 0%, p=0.0002).ConclusionThis study shows that dipyrone should be used with caution in aspirin-treated patients. If dipyrone seems indispensable, the lowest effective dose and a strict order of intake seem favorable.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0031-6970
• Sprache: Englisch