Ciencias

Coumarin derivatives/ salicylates
Risk rating: consider therapy modification.
Summary:
Salicylates may enhance the anticoagulant effect of coumarin derivatives. Serevity: major. Onset: notspecified. Reliability rating: excellent.
Patient management:
Patients receiving coumarin derivatives should not take salicylate-containing medicines on an asneeded basis. Nonacetylated salicylates mightbe safer that aspirin. Acetaminophen ( <2g/day for <1 week) is usually a good antipyretic and analgesic choice for patients taking coumarin derivatives. Coution with careful monitoring, for theprevention of cardiovascular events. Monitor for increased signs and symtoms of bleeding if a coumarin derivative and a salicylate are used concomitantly. Aspirin does >325 mg?day may require morefrequent INR monitoring. Note: with smaller aspirin does (eg. <3 g?day), the INR might not be affected but increased risk of bleeding is still present due to other pharmacologic effects of aspirin.Interactin members
Coumarin derivatives interacting members> aminosalicylate sodium; aspirin; choline magnesium trisalicylate; choline salicylate; salsalate; sodium salicylate.
DiscussionConcomitant therapy with aspirin an oral anticoagulants has beeb shown to significantly increase the risk of bleeding, both major and minor. In a 534/patient study excessive bleeding (requiring bloodtransfusion or hospitalization) was three times higher in those receiving warfarin and aspirin (500mg?day), than in those receiving warfarin and dipyridamole (400 mg?day) or warfarin alone. Bleedingevents primarily involved the gastrointestinal tract or central nervous system (all patients who experienced cerebral bleeds died).other reports provide similar data. Though the risk bleeding, especiallygastrointestinal, in increased by even small doses of aspirin, a study using daily 3g doses failed patients. This support the prevailing thought of the involvement of multiple mechanisms associated...