Unfortunately, there is also evidence that the use of aspirin combined with either Celebrex or the older NSAIDs can increase the risk of gastrointestinal bleeding.
Dr. Gurkirpal Singh gathered his data from records kept on California Medicare patients with rheumatoid arthritis or osteoarthritis. He found that the risk of heart attack was increased by 31 percent in patients treated with Vioxx, and by 12 percent in patients treated with Celebrex.
But he also found the risk of heart attack increased by 65 percent in patients on indomethacin, 52 percent in patients on Mobic, and by 47 percent in patients on sulindac.
The use of aspirin reversed the increased risk of heart attack in patients taking Vioxx, Celebrex, Mobic, and sulindac. However, patients on indomethacin and aspirin still had a 20 percent increased risk of heart attack.
It would appear that the 24 hour of inhibition of clotting that one aspirin provides protects from heart attack. But doctors and patients must remember the risk of bleeding from the gastrointestinal tract with chronic aspirin use combined with NSAID use.
At this time, the U.S. Food and Drug Administration has warnings on the increased cardiovascular risk with the use of NSAIDs, Cox-2 selective and otherwise.
More studies need to be done to determine whether medications to protect against gastrointestinal bleeding can adequately protect patients with chronic pain on both aspirin and drugs such as Celebrex or sulindac or indomethacin, etc.