Interactive Question 10

clopidogrel

Incorrect.  There are several well-studied regimens which demonstrate a clinical advantage of combining aspirin and clopidogrel, including for patients with acute coronary syndrome who undergo coronary stenting.

proton-pump inhibitors

Incorrect.  In patients who have a gastrointestinal hemorrhage while taking aspirin, addition of a proton-pump inhibitor can reduce the risk of a subsequent bleed.

ticagrelor (Brilinta)

Incorrect.  Ticagrelor should be used in combination with aspirin.  Ticagrelor plus aspirin is more efficacious than clopidogrel plus aspirin but also increases the risk of major bleeding.

ibuprofen

Correct.  The American Heart Association and the American College of Cardiology recommend against the use of ibuprofen in patients taking aspirin. In vivo studies have found that some non-steroidal anti-inflammatory drugs inhibit aspirin's antiplatelet activity and several clinical studies have suggested that patients taking ibuprofen and aspirin together may be at a higher risk of cardiovascular events than patients taking aspirin alone or in combination with other non-steroidal anti-inflammatory drugs.