Non-steroidal anti-inflammatory drugs (NSAIDs) are linked to a significantly increased risk of internal bleeding when taken by patients who are already taking anticoagulants, according to a new study.
The Danish study is based on data from nationwide registries of 51,794 people treated over a ten-year period with anticoagulants for venous thromboembolism.
Researchers led by a team from Aarhus University found increased risks of bleeding in the brain, lungs, gut and urinary tract associated with use of NSAIDs.
The risk was increased four times among patients who took naproxen, and by three times among those who used diclofenac. The risk among those taking ibuprofen was doubled, according to the study, published in the European Heart Journal.
The Danish researchers acknowledge they cannot account for ibuprofen bought over the counter – but say that in Denmark 75% of the use of the drug is through prescription.
Researcher Mr Søren Riis Petersen, from Aarhus University Hospital, said: “We found that for patients taking blood thinners for blood clots in the legs or lungs, using NSAIDs doubled the risk of bleeding compared with not using NSAIDs. The increased bleeding risk associated with NSAID use was not limited to the digestive tract but also seemed to affect other organ systems.
“For people taking blood thinners for blood clots in their legs or lungs, our research highlights the importance of being cautious when considering NSAIDs for pain or inflammation. We recommend that patients consult their doctor before taking NSAIDs along with a blood thinner.”
In an accompanying editorial article, Professor Robert Storey, of the University of Sheffield, said: “It seems clear that avoiding NSAIDs in combination with OAC is the safest strategy to avoid excess bleeding risk. However, if this is not possible, what mitigation can be put in place? NSAID prescription should obviously be at the lowest dose and for the shortest time possible, but choice of agent and route may also be important.
“An episode of VTE mandates initiation of anticoagulation, usually an OAC, in all but the rarest of circumstances. However, when doing so, physicians must consider the full context of a patient’s bleeding risk factors, including NSAID use. It is important to appropriately counsel the patient, consider alternatives to NSAIDs, including non-pharmacological therapies, and pursue all possible mitigation strategies to reduce the chance of an adverse outcome.”
Source:
Petersen SR, Bonnesen K, Grove EL, Pedersen L, Schmidt M. (2024) “Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study.” European Heart Journal, 18 November 2024, doi: 10.1093/eurheartj/ehae736.
Link: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae736/7900494
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