Вот, если интересно, небольшой обзорчик, немного старенький, правда:
Update on the Interaction Between Aspirin and Angiotensin-Converting Enzyme Inhibitors. James J. Nawarskas, Pharm.D.
Основные выводы:
Interaction Between Aspirin and Enzyme Inhibitors
from Pharmacotherapy
Conclusion
Although a potential aspirin-ACE inhibitor interaction has been the subject of much research over the past few years, relatively little remains known regarding its frequency and severity. Published studies are largely contradictory, although some extrapolations can be made: (1) low-dose aspirin (</= 100 mg/day) appears to cause fewer interactions than higher dosages; (2) the aspirin-ACE inhibitor interaction may occur in patients with hypertension, coronary artery disease, or heart failure; and (3) interindividual susceptibilities to the interaction may likely be present. Solutions to these issues will likely be found only in randomized, prospective, placebo-controlled trials.
Вот еще один:
From Congestive Heart Failure
Should Aspirin Be Used With Angiotensin-Converting Enzyme Inhibitors in Patients With Chronic Heart Failure?
Posted 09/09/2003
Myung H. Park, MD
Abstract
Aspirin and angiotensin-converting enzyme (ACE) inhibitors are widely used in combination to treat a wide spectrum of cardiac disorders. Theoretically, a rationale for interaction between these two agents exists in the possible counterbalancing prostaglandin inhibiting actions of aspirin and the vasodilatory prostaglandin promoting effects of ACE inhibitors. Animal and human studies suggest such an interaction, but most are plagued by small numbers or retrospective designs. Large-scale trials are in progress to address this issue. Until then, the key factor in deciding whether a patient with ischemic heart disease on ACE inhibitor therapy should be placed on aspirin therapy may largely depend on the severity of heart failure. The more severe the heart failure, the more likely an appreciable interaction between aspirin and ACE inhibitors will occur. Treatment with either low-dose aspirin or with alternative agents, such as warfarin or clopidogrel, may be the best therapeutic approach for patients with severe systolic heart failure.
Так, что посмотрим, что получится. Думаю, что производители Plavix помогут нам разобраться с аспириновыми проблемами при помощи уважаемых спикеров и красивых постеров. Тем не меее пока своим пациентам с ASA назначать буду, но только по 81 mg.
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