Use of Topical Diclofenac in Coronary Artery Disease With Aspirin Therapy
Topical diclofenac (Voltaren gel) carries a boxed warning for serious cardiovascular thrombotic events and gastrointestinal bleeding risks, similar to other NSAIDs. [1]
With concomitant aspirin therapy, diclofenac topical therapy is associated with increased bleeding risk, and concomitant use with analgesic doses of aspirin is not generally recommended. [1]
Cardiovascular and Bleeding Risks Relevant to Aspirin-Use
VOLTAREN GEL labeling includes a risk of cardiovascular thrombotic events and heart failure, with warnings that apply to NSA-class effects. [1]
VOLTAREN GEL labeling notes that NSAIDs may increase bleeding risk and that concomitant use of antiplatelet agents (including aspirin) may increase this risk, with monitoring for bleeding advised. [1]
VOLTAREN GEL labeling specifically states that concomitant use with analgesic doses of aspirin is not generally recommended due to increased bleeding risk. [1]
Interaction With Aspirin: Practical Clinical Interpretation
Concomitant aspirin use increases bleeding risk when NSAID therapy is used. [1]
Concomitant use of VOLTAREN GEL with analgesic-dose aspirin is discouraged because increased GI/bleeding risk has been observed with diclofenac plus aspirin in the context of NSAID–aspirin coadministration. [1]
AHA communications on NSAID use in patients with cardiovascular disease emphasize minimizing NSAID use and using the lowest effective dose when NSAIDs are required. [2]
Clinical Use Approach for a Patient Taking Aspirin
VOLTAREN GEL may be considered for localized musculoskeletal pain when benefits outweigh risks, but clinicians should minimize NSAID exposure and use the lowest effective regimen in patients with cardiovascular disease. [2]
Bleeding risk should be monitored during use in patients receiving antiplatelet therapy, including aspirin. [1]
Concomitant use with other NSAIDs should be avoided unless benefit clearly outweighs risk because of additive toxicity risk. [1]
When Topical Diclofenac Should Not Be Used
VOLTAREN GEL is contraindicated in patients with a history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. [1]
VOLTAREN GEL is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. [1]
Key Safety Monitoring Considerations
Monitoring for signs of bleeding is recommended in patients taking antiplatelet agents with NSAID therapy. [1]
Patients should be counseled to seek medical care for anemia or bleeding symptoms during NSAID therapy. [1]
Summary Statement
In a patient with coronary artery disease taking aspirin, topical diclofenac should be used only when clinically necessary, with minimized dosing and monitoring for bleeding, because concomitant NSAID and aspirin therapy increases bleeding risk and analgesic-dose aspirin co-use is not generally recommended. [1], [2]