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Dr Dalen's¹ reply to the comments of Mukherjee and colleagues² suggests the possibility of a clinical trial to attempt to answer the question if naproxen decreases the risk of myocardial infarction or if cyclooxygenase inhibitors increase the risk. One of the proposed treatment arms would include patients receiving both naproxen and aspirin. To be credible, such a project would require a preliminary evaluation to see if there is any modulation of the cardioprotective effect of naproxen when it is used in conjunction with aspirin. A previously published study with ibuprofen (another propionic acid derivative) showed a blockage of aspirin's effect on inhibition of thromboxane B₂ formation as well as platelet aggregation.³

Stephen Schechter, MD
Bethesda, Md

1. Dalen JE. In reply [letter]. Arch Intern Med. 2002;162:2638-2639. 2. Mukherjee D, Nissen SE, Topol EJ. Lack of cardioprotective effect of naproxen [letter]. N Engl J Med. 2002;162:2637. 3. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345:1809-1817. FREE FULL TEXT

Arch Intern Med. 2003;163:1374.