Acetylcholine pgmin

— No-atherosclerosis _ Aspirin

LL4 3

0 150 300

Acetylcholine (pg/min)

FVRI: femoral vascular resistance index Figure 2.30 Reduced endothelium-dependent relaxation of femoral arteries in patients with advanced atherosclerosis (a). Improvement by intravenous soluble aspirin (1 g) in patients with atherosclerosis (b) but not in nonatherosclerotic controls (c). (modified after [303]).

coxib/valdecoxib) subjected to coronary artery bypass surgery exhibited a significant increase in cardiovascular events within a few days - though being on aspirin treatment [309]. The reason for this therapeutic failure of aspirin is unknown. Possibly, the hemostatic equilibrium in these patients depends on the continuous formation of antiplatelet, vasodilatory prostaglandins via an up-regulated COX-2 in the vessel wall. A more detailed discussion of the clinical aspects of these drug interactions is found in Section 4.1.1.

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