A 58-year-old woman who is obese presents to the emergency department with diaphoresis and crushing.

A 58-year-old woman who is obese presents to the emergency
department with diaphoresis and crushing chest pain that radiates to her left
arm. The physician orders an ECG and checks her cardiac enzymes to confirm his
suspicion of myocardial infarction. Because of the quick response and
intervention, she survives and is ultimately discharged with a prescription for
low-dose daily aspirin to inhibit platelet aggregation. Two weeks after
discharge, she takes ibuprofen for a tension headache. What is the effect of the
ibuprofen on her anticoagulation regimen?

(A) Excessive antiplatelet activity because of a synergistic
action between aspirin and ibuprofen on platelets

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(B) Excessive antiplatelet activity because of ibuprofen’s effects
on endothelial cells combined with aspirin’s effects on platelets

(C) Insufficient antiplatelet activity because ibuprofen induces
liver cytochrome P450 metabolism of aspirin

(D) Insufficient antiplatelet activity because of inadequate
platelet cyclooxygenase inhibition

(E) No change

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