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To the Editor: The US Food and Drug Administration recently announced the premature discontinuation of ADAPT due to an apparent increase in adverse cardiovascular events associated with naproxen.¹ Because previous reports have shown naproxen to have a cardioprotective effect, this finding was unexpected and has caused a considerable amount of confusion among practitioners and the public.²

ADAPT and other similar trials evaluating the effect of long term exposure to NSAIDs allow patients to continue receiving cardioprotective doses of aspirin (<325 mg/d) without controlling for allocation between arms, timing of aspirin administration in relationship to the NSAID dose, or dosage form of aspirin used (soluble vs enteric coated).³ Catella-Lawson et al⁴ observed that administration of ibuprofen (a propionic acid derivative similar to naproxen) with or prior to aspirin negates the antiplatelet effect of aspirin by binding to a serine residue in the channel that aspirin must traverse before it can access . . . [Full Text of this Article]

David F. Lehmann, MD, PharmD
lehmannd@upstate.edu
State University of New York Upstate Medical University
Syracuse

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