DOI QR코드

DOI QR Code

Bleeding after Taking Dual Antiplatelets and NSAID Concurrently

항혈소판제와 비스테로이드성소염진통제의 동시 투약으로 인한 출혈 사례

  • 서정민 (가천대학교 약학대학) ;
  • 최중혁 (가천대학교 약학대학) ;
  • 손병우 (가천대학교 약학대학) ;
  • 이승민 (가천대학교 약학대학) ;
  • 채현우 (가천대학교 약학대학) ;
  • 강근형 (인천광역시약사회 의약품식품안전센터) ;
  • 지은희 (가천대학교 약학대학)
  • Received : 2018.07.10
  • Accepted : 2018.09.04
  • Published : 2018.09.03

Abstract

When stenting is applied to treat myocardial infarction, antiplatelet agents are administered to prevent thrombosis, which increases the risk of bleeding. Patients with myocardial infarction are also more likely to have osteoarthritis simultaneously, because both diseases occur frequently in elderly patients. Patients with osteoarthritis often use analgesics, especially nonsteroidal anti-inflammatory drugs (NSAIDs); hence, patients with both diseases use analgesics and antiplatelet agents simultaneously. The risk of bleeding increases with the use of antiplatelet agents and this is further increased when NSAIDs are added. We would like to report a case that reflects this situation. A 60-year-old man underwent stenting after ST-elevation myocardial infarction, and was treated with aspirin and clopidogrel. This patient also received a pelubiprofen prescription from another physician to treat osteoarthritis. After the patient took pelubiprofen twice, he found a bruise on his wrist and reported it to the pharmacist. It is unlikely that this is rare in community pharmacies, so pharmacists should pay careful attention to the concomitant administration of analgesics to patients receiving antiplatelet agents and should provide appropriate education to patients.

Keywords

References

  1. Wu C, Camacho FT, Zhao S, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg 2013;95(4):1297-305. https://doi.org/10.1016/j.athoracsur.2012.11.073
  2. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016;68(10):1082-115. https://doi.org/10.1016/j.jacc.2016.03.513
  3. Andell P, James SK, Cannon CP, et al. Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial. J Am Heart Assoc 2015;4(10):e002490. https://doi.org/10.1161/JAHA.115.002490
  4. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012;64(4):465-74. https://doi.org/10.1002/acr.21596
  5. Korean Knee Sciety. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res 2012;24(4):201-7. https://doi.org/10.5792/ksrr.2012.24.4.201
  6. Greengard S, Kinman T. Managing Postoperative Pain, Swelling, and Bruising After Total Knee Replacement. Available from https://www.healthline.com/health/total-knee-replacement-surgery/manag-ing-postoperative-pain. Accessed April 20, 2018.
  7. Korea Centers for Disease Control & Prevention. Epidemiology and Management of Cardio-cerebrovascular Disease for Preventive Management of Community Cardio-cerebrovascular Disease 2013:518.
  8. Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. Engl J Med 2014;371(23):2155-66. https://doi.org/10.1056/NEJMoa1409312
  9. He F, Xia C, Zhang JH, et al. Clopidogrel plus aspirin versus aspirin alone for preventing early neurological deterioration in patients with acute ischemic stroke. J Clin Neurosci 2015;22(1):83-6. https://doi.org/10.1016/j.jocn.2014.05.038
  10. Liu Y, Liu H, Hao Y, et al. Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study. Kardiol Pol 2017;75(9):850-8. https://doi.org/10.5603/KP.a2017.0116
  11. van Hecken A, Depre M, Wynants K, et al. Effect of clopidogrel on naproxen-induced gastrointestinal blood loss in healthy volunteers. Drug Metabol Drug Interact 1998;14(3):193-205.
  12. Liu L, Wong KS, Leng X, et al. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology 2015;85(13):1154-62. https://doi.org/10.1212/WNL.0000000000001972
  13. Schafer AI. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol 1995;35(3):209-19. https://doi.org/10.1002/j.1552-4604.1995.tb04050.x
  14. Meek IL, Van de Laar MA, H EV. Non-Steroidal Anti-Inflammatory Drugs: An Overview of Cardiovascular Risks. Pharmaceuticals (Basel) 2010;3(7):2146-62. https://doi.org/10.3390/ph3072146
  15. Schror K. Aspirin and platelets: the antiplatelet action of aspirin and its role in thrombosis treatment and prophylaxis. Semin Thromb Hemost 1997;23(4):349-56. https://doi.org/10.1055/s-2007-996108
  16. Warner TD, Nylander S, Whatling C. Anti-platelet therapy: cyclo-oxygenase inhibition and the use of aspirin with particular regard to dual anti-platelet therapy. Br J Clin Pharmacol 2011;72(4):619-33. https://doi.org/10.1111/j.1365-2125.2011.03943.x