Interaction between antiplatelet agents and ACE inhibitors in patients with acute myocardial infarction

Aspirin is the current mainstay of antiplatelet therapy. Both aspirin and A CE inhibitors independently reduce mortality in acute myocardial infarction patients. However. the clinical outcome from large prevention and treatmen t trials suggests that these agents have antagonistic actions. The antagoni sm may be related to opposing modulatory effects on prostaglandin synthesis : ACE inhibition can potentiate bradykinin, resulting in increased synthesi s of the prostaglandin precursor arachidonic acid, whereas aspirin is an in hibitor of the prostaglandin-synthesizing enzyme cyclo-oxygenase. New salic ylates with reduced affinity for cyclo-oxygenase, such as triflusal, have a reduced potential for such antagonism.