Moderate
Acetylsalicylic acid × celecoxib
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Selective COX-2 inhibitor (coxib)
Mechanism
Celecoxib is a selective COX-2 inhibitor and does not displace aspirin from COX-1 (unlike ibuprofen/naproxen). Aspirin's antiplatelet effect is preserved. Additive GI bleeding risk persists.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black or tarry stools. Severe cases: GI bleeding.
Management
The combination is acceptable. Aspirin's cardioprotective effect is preserved. PPI cover with pantoprazole is mandatory in chronic celecoxib therapy. Check blood pressure and creatinine every 3 months.