Propacetamol augments inhibition of platelet function by diclofenac in volunteers

Munsterhjelm, E.; Niemi, Tomi; Syrjälä, Martti; Ylikorkala, Olavi; Rosenberg, P. H.

doi:10.1093/bja/aeg195

Cited by 33 publications

(28 citation statements)

References 25 publications

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“…Yet, in vivo studies have failed to prove competitive interaction between aspirin and diclofenac in platelet aggregation, or suggest minimal effect of diclofenac on platelet aggregation, when administered concurrently with aspirin [9,10] . On the other hand, additive or synergistic effects between antiplatelet agents acting via different mechanisms as well as paracetamol, a weak COX inhibitor and diclofenac have been demonstrated [11][12][13] . But how could synergistic or even additive effect between aspirin that irreversibly blocks COX I activity and diclofenac that reversibly blocks COX I activity be justified?…”

Section: Discussionmentioning

confidence: 99%

Hemoptysis under Diclofenac and Antiplatelet Doses of Aspirin

Yiannakopoulou

2010

Pharmacology

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A previously healthy 60-year-old man receiving aspirin for primary prevention of cardiovascular disease presented with hemoptysis after 1 week of treatment for his back pain with diclofenac. He had not suffered from any bleeding episode in the past and his family history was negative for hemorrhagic disorders. He had been a heavy smoker until his thirties, but had stopped smoking since then. After extensive workup, other pulmonary and nonpulmonary causes of hemoptysis were ruled out. Thus, in this case, because of the temporal relationship between exposure to the drug and the onset of symptoms, diclofenac was considered as the most probable cause of hemoptysis either alone or as a result of its pharmacodynamic interaction with aspirin. The adverse reaction was considered probable according to the Naranjo scale. Diclofenac treatment was discontinued and occasional use of acetaminophen for the back pain was recommended. Regular use of antiplatelet doses of aspirin was also discontinued.

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Section: Discussionmentioning

confidence: 99%

Hemoptysis under Diclofenac and Antiplatelet Doses of Aspirin

Yiannakopoulou

2010

Pharmacology

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“…However, recent studies of human volunteers have shown greater inhibition of thromboxane A2 release with a combination of diclofenac and paracetamol compared to diclofenac, suggesting that the combination may be associated with more side effects. 18 Furthermore, an animal model has shown that the combination of diclofenac and morphine is synergistic and the combination of paracetamol and morphine is additive. 19 However, since this study was completed, we have changed our choice of spinal opioid from fentanyl to diamorphine, and dispensed with PCA morphine.…”

Section: Discussionmentioning

confidence: 99%

A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section

Munishankar

Fettes

Moore

et al. 2008

International Journal of Obstetric Anesthesia

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“…On the other hand, Hegi et al [12] compared the effect of selective COX-2 blocker rofecoxib and nonselective COX inhibitor diclofenac in patients undergoing gynaecological and breast surgery, and found increased estimated blood loss and greater reduction in haemoglobin in nonselective COX inhibitor users, and Graff et al [13] showed that there is an association between COX inhibition and haemorrhagic complications in various clinical settings. In a recent systematic review of NSAIDs and bleeding after tonsillectomy, increased risk for reoperation after use of NSAIDs was found [14,15]. Likewise pretreatment with ibuprofen appears to increase perioperative blood loss during hip replacement [16] and low-dose aspirin has the same effect given before transurethral Bleeding Severity Score of Patients With Normal and Impaired Platelet Function prostatectomy [17].…”

Section: Discussionmentioning

confidence: 99%

The effects of nonsteroidal anti-inflammatory drugs on platelet function and severity of upper gastrointestinal haemorrhage

Paşa

Bayan

Küçüköner

et al. 2008

J Thromb Thrombolysis

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Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal (GI) damage primarily due to the inhibition of prostaglandin synthesis in gastric mucosa, which is an important factor in mucosa protection. Platelets are a cardinal feature of vascular repair. A variety of angiogenic stimulators are stored in platelets and are released during clotting at the wound. When there is a defect in any of these functions and/or platelet number, haemostasis is usually impaired and there may be an associated increased risk and severity of bleeding. While the mechanism of mucosal injury and bleeding are well documented with the use of NSAIDs, very little is known about the platelet function abnormalities and their effects on severity of upper GI bleedings. We performed a prospective analysis of 49 patients who had a history of NSAIDs use to investigate the association between the platelet function impairment associated with NSAIDs and severity of upper GI haemorrhages. Thirty-six of 49 patients (73.5%) had deteriorated platelet function. Mean severity score of patients with deteriorated platelet functions was 3.39, and that of patients with normal platelet functions was 2.46. Mean severity score was statistically significantly higher in patients with deteriorated platelet functions. In conclusion, impaired platelet functions associated with NSAIDs may cause more severe upper GI bleeding. Clinicians should be alert for GI complications especially in older patients and in those with a history of ulcer bleeding.

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Propacetamol augments inhibition of platelet function by diclofenac in volunteers

Abstract: The combination of propacetamol and diclofenac inhibits platelet function more than diclofenac alone. This should be considered when assessing the risk of surgical bleeding.

Cited by 33 publications

References 25 publications

Hemoptysis under Diclofenac and Antiplatelet Doses of Aspirin

Hemoptysis under Diclofenac and Antiplatelet Doses of Aspirin

A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section

The effects of nonsteroidal anti-inflammatory drugs on platelet function and severity of upper gastrointestinal haemorrhage

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