Pyrazolinone analgesics prevent the antiplatelet effect of aspirin and preserve human platelet thromboxane synthesis

Hohlfeld, Thomas; Zimmermann, Norbert; Weber, Artur Aron; Jessen, Gisela; Weber, Horst; Schrör, Karsten; Höltje, Hans‐Dieter; Ebel, Rainer

doi:10.1111/j.1538-7836.2007.02800.x

Cited by 59 publications

(30 citation statements)

References 38 publications

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“…The significance of this interaction was proven in healthy volunteers for ibuprofen and dipyrone, which are widely used as perioperative analgesics in Central Europe [10]. Also, a few observational studies have confirmed the clinical importance of adverse interactions between ASA and NSAIDs in clinical settings [12, 13, 27]. In patients with coronary artery disease, dipyrone was shown to nullify the antiplatelet efficacy of ASA soon after coronary artery bypass graft surgery [14].…”

Section: Discussionmentioning

confidence: 99%

Role of Dipyrone in the High On-Treatment Platelet Reactivity amongst Acetylsalicylic Acid-Treated Patients Undergoing Peripheral Artery Revascularisation

et al. 2018

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Objective: To evaluate the effects of dipyrone on sensitivity to aspirin (acetylsalicylic acid [ASA]) in patients who underwent peripheral artery vascular reconstruction. Subjects and Methods: Impedance aggregometry and light transmission aggregometry were used to determine the effects of dipyrone on ASA treatment in 21 patients. Blood samples were drawn in a 7-day period after the surgery. The cut-off value for high on-treatment platelet reactivity (HTPR) was set at < 65% of aggregation inhibition for impedance aggregometry. For light transmission aggregometry the cut-off value for arachidonic acid-induced aggregation was set at > 20% of aggregating platelets, and the cut-off value for epinephrine-induced aggregation was > 44% of aggregating platelets. The cut-off value for each method was derived from a large number of patients treated with a daily dose of 100 mg of ASA. Results: We found HTPR in 14 (67%) of the 21 patients. None had primary resistance to ASA, i.e., after the addition of ASA in vitro all samples showed antiplatelet efficacy. Regression analysis showed a possible correlation between lower efficacy of ASA treatment and higher daily doses of dipyrone (p = 0.005 for impedance aggregometry, p = 0.04 for light transmission aggregometry), higher platelet count (p = 0.005 for impedance aggregometry), and shorter time from surgery (p = 0.03 for impedance aggregometry). Conclusion: HTPR occurs in 67% of ASA-treated patients after lower limb vascular surgery. The occurrence of HTPR correlates with the daily dose of dipyrone. Therefore, dipyrone should not be used as a postoperative analgesic in ASA-treated patients after peripheral artery revascularisation due to its influence on the effectiveness of ASA.

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Section: Discussionmentioning

confidence: 99%

Role of Dipyrone in the High On-Treatment Platelet Reactivity amongst Acetylsalicylic Acid-Treated Patients Undergoing Peripheral Artery Revascularisation

et al. 2018

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“…Pyrazolone, as well as other nonsteroidal antiinflammatory drugs, has been shown to interfere with the inhibitory effect of ASA on the synthesis of thromboxane within the normal therapeutic range. 23,24 Polzin et al demonstrated that this interaction has a relevant in vivo effect in patients with coronary artery disease. 25 The postoperative analgesic therapy in both centers included a basal medication with the pyrazolinone metamizole, which could have had an additive effect on the incidence of ASA nonresponse.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Wand

Adam

Wetz

et al. 2017

Clin Appl Thromb Hemost

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We aimed to identify the prevalence of acetylsalicylic acid (ASA) nonresponse in patients after coronary artery bypass graft (CABG) surgery and the possible consequences for the rate of major cardiovascular events. This prospective, observational, bicentric cohort study was conducted in two German University hospitals. A total of 400 patients (200 in each study center) undergoing elective CABG surgery were enrolled after written informed consent. Platelet function was analyzed on day 3 (d3) and day 5 (d5) postoperatively following stimulation with arachidonic acid (ASPItest) and with thrombin receptor-activating peptide 6 (TRAPtest) using multiple electrode aggregometry (Multiplate). Individuals with an ASPItest !40 AUÁmin were categorized as ASA nonresponders. A 1-year follow-up recorded the combined end point of cardiovascular events, hospital admissions, or deaths related to cardiovascular disease. The prevalence of ASA nonresponse was 51.5% on d3, and it significantly increased to 71.3% on d5 (P ¼ .0049). The area under the aggregation curve in the TRAPtest (P < .0001), the platelet count on d5 (P ¼ .009), and the cardiopulmonary bypass time (P ¼ .01) were identified as independent predictors of an ASA nonresponse. A 1-year follow-up recorded 54 events fulfilling criteria for the combined end point with no difference between ASA responders and nonresponders. This study indicates a high incidence of perioperative ASA nonresponse in patients following CABG. No effect on the incidence of cardiovascular events was recorded in the 1-year follow-up. Therefore, a randomized dosage adjustment trial should elucidate whether a tailored ASA treatment after CABG surgery represents a useful concept.

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“…Aufgrund der vergleichsweise kurzen Halbwertszeit von ASS im Plasma (15-20 min) ist ASS deshalb bereits weitestgehend zu Salizylsäure hydrolysiert, wenn die NSAID die Bindungsstelle im COX-Kanal wieder freigeben. Die Abschwächung der ASSinduzierten Thrombozyteninhibition bei gleichzeitiger Behandlung mit NSAID, aber auch mit Metamizol [17], wird klinisch wenig beachtet.…”

Section: Azetylsalizylsäureunclassified

Klinische Pharmakologie der aktuellen antithrombozytären Substanzen

Trenk

Nührenberg

Stratz

et al. 2014

Herz

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Dual antiplatelet therapy with low-dose acetylsalicylic acid (ASA) and an inhibitor of the P2Y12 adenosine diphosphate (ADP) receptor is the standard treatment for patients presenting with acute coronary syndrome (ACS) or undergoing elective coronary interventions according to the current guidelines published by the European Society of Cardiology (ESC). New generation P2Y12 inhibitors, such as prasugrel and ticagrelor exert stronger and more consistent inhibition of the P2Y12 receptor. In clinical studies enrolling patients with ACS these drugs decreased the incidence of ischemic events compared to the standard therapy with clopidogrel and ASA; however, this beneficial effect was associated with an increase in bleeding events. Alternative therapeutic approaches via addition of drugs with different modes of action showed an overall reduction of ischemic events but also failed to uncouple this beneficial effect from an increased bleeding risk.

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Pyrazolinone analgesics prevent the antiplatelet effect of aspirin and preserve human platelet thromboxane synthesis

Cited by 59 publications

References 38 publications

Role of Dipyrone in the High On-Treatment Platelet Reactivity amongst Acetylsalicylic Acid-Treated Patients Undergoing Peripheral Artery Revascularisation

Role of Dipyrone in the High On-Treatment Platelet Reactivity amongst Acetylsalicylic Acid-Treated Patients Undergoing Peripheral Artery Revascularisation

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Klinische Pharmakologie der aktuellen antithrombozytären Substanzen

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