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Ibuprofen
Could Be Bad for Heart Patients
WARN YOYR PATIENTS!
Patients
who take low-dose aspirin for cardioprotection should not take
ibuprofen.
Fresh
evidence adds to suspicions that ibuprofen could be dangerous for
most heart patients because it can block the blood-thinning
benefits of aspirin.
New
research published this week in The Lancet medical journal found
that those taking both aspirin and ibuprofen were twice as likely
to die during the study period as those who were taking aspirin
alone or with other types of common pain relievers.
Scientists
believe ibuprofen clogs a channel inside a clotting protein that
aspirin acts on. Aspirin gets stuck behind the ibuprofen and
cannot get to where it is supposed to go to thin the blood.
Aspirin
is considered the most important medicine for heart disease.
Nearly all heart patients take it every day because it prevents
the clots that cause heart attacks and strokes. Ibuprofen, which
is in Motrin and Advil among other brands, is widely used for
arthritis and other aches and pains.
Scientists
at the Medicines Monitoring Unit of Britain's Medical Research
Council checked the medical records of 7,107 heart patients who
had been discharged from hospitals between 1989 and 1997 with
aspirin prescriptions and had survived at least one month after
leaving the hospital.
They
were divided into four groups according to their prescriptions.
The
first group included those on aspirin alone.
The second were given aspirin and ibuprofen and the third
group had aspirin with another pain killer, diclofenac. Ibuprofen
and diclofenac both belong to a widely used class of pain
relievers known as nonsteroidal anti-inflammatory drugs, or
NSAIDs.
The
last group included those taking aspirin with any other NSAID,
such as acetaminophen, which is in Tylenol.
The
researchers found that those taking ibuprofen were almost twice as
likely as those taking aspirin alone to die by 1997. That meant
that for every 1,000 patients treated, there were 12 extra deaths
a year when ibuprofen was taken with aspirin.
For
heart-related deaths, ibuprofen was linked to three extra deaths
per 1,000 patients treated per year.
Experts
say it is important to track both heart-related deaths and deaths
in general because deaths are sometimes attributed to the wrong
cause and heart-related cases may be missed. For instance, a death
certificate may say the person died in a car crash when, in fact,
a heart attack or stroke at the wheel caused the crash.
No
extra deaths were seen in the groups taking the other types of
NSAIDs.
The
message here is beginning to be 'go for something other than
ibuprofen,''' said Garret FitzGerald, who was not connected with
the latest study, but whose research sparked concerns about the
combination just over a year ago.
Mechanistically,
you have a very clear rationale for why it should happen,'' said
FitzGerald, professor of cardiovascular medicine and chair of
pharmacology at the University of Pennsylvania. ``Now we have four
studies each coming out with the same message. It's several pieces
of ancillary evidence that when assembled are more persuasive than
when taken in isolation.''
Lots
of people take these two kinds of drugs chronically and probably a
large number take both together chronically,'' FitzGerald said.
``Talk to your doctor before you embark on this combination
thinking that it's totally innocuous because both are available
over the counter.''
Dr.
Tom MacDonald, who led the Lancet study, said taking the odd
ibuprofen for a few days would not be a problem. It's regular use
that seems to be at issue.
But
the findings are not rock solid, experts said.
This
definitely raises a red flag ... but I don't think this can be
viewed as the definitive answer on the question,'' said Dr.
Veronique Roger, head of cardiovascular research at the Mayo
Clinic in Rochester, Minn., who was not connected to the study.
It
could be that heart patients who take ibuprofen have additional
conditions that in turn make them more prone to premature death
and were not accounted for in the study, she noted.
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