First aid

15 April 2014

Taking NSAIDs with blood thinners ups bleeding risk

Taking an NSAID, such as aspirin, while taking an anticoagulant doubles the risk of a major bleed.


People taking blood thinners to prevent clots in their legs or lungs may put themselves at risk for serious internal bleeding if they also take common painkillers such as aspirin or ibuprofen, researchers warn.

These over-the-counter painkillers – called non-steroidal anti-inflammatory drugs (NSAIDs) – include such drugs as Advil, Aleve, Bufferin, Excedrin, Motrin and Nuprin, as well as aspirin. Patients who use blood thinners such as warfarin, Eliquis, Xarelto or Pradaxa should not take them, the researchers said.

"If you are taking an NSAID while taking an anticoagulant, your risk of a major bleed is double what it would be if you weren't taking an NSAID," said lead researcher Dr Bruce Davidson. He's with the division of pulmonary and critical care medicine at the University of Washington School of Medicine in Seattle.

Read: Gene thwarts blood thinner drug

One-quarter of these major bleeds happen within eight days of taking an NSAID, Davidson said. "It's not like you have to be taking them for weeks or months. Some bleeds happen with a single dose," he said.

Risk of bleeding

The risk of bleeding might be even greater for people with an irregular heartbeat, called atrial fibrillation, who take a blood thinner and use an NSAID, Davidson said.

"The message for people is if you're taking a blood thinner, do not take an NSAID – just don't take one," Davidson said.

"If you have a headache or aching muscles or joints, take generic Tylenol [acetaminophen]. Don't take NSAIDs for casual use," he added.

The report, published online in JAMA Internal Medicine, said the bleeding is often minor but can be fatal in some cases.

Anticoagulant therapy

It's known that aspirin use by patients on anticoagulant therapy doubles the risk of bleeding, said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and spokesman for the American Heart Association.

Read: NSAIDs help some cold symptoms

But whether NSAIDs such as Advil or Motrin are associated with increased risk of bleeding among patients receiving anticoagulant therapy wasn't clear, Fonarow said.

Some studies showed raised risk with drugs like Coumadin (warfarin), Eliquis (apixaban), Xarelto (rivaroxaban) or Pradaxa (dabigatran), while others didn't.

Patients should consult their doctor before combining these medications, he advised.

Preventing blood clots

For the study, Davidson's team analysed data from the worldwide EINSTEIN deep vein thrombosis and pulmonary embolism studies, which included over 8000 patients. The trials compared two blood thinners – Xarelto and warfarin – to see which was better at preventing blood clots in the legs and lungs.

Drugs that prevent clotting always carry the additional risk of internal bleeding, which can become serious and life-threatening, experts say.

Read: What different types of painkillers do we find?

Davidson's group also looked at whether taking NSAIDs with these blood thinners might increase the risk for bleeding. They found it did.

He said that, according to the study, the absolute risk for a major bleeding episode for a patient taking aspirin and a blood thinner was nearly double that of a patient not on aspirin. For patients taking another form of NSAID plus a blood thinner, there was triple the risk compared to those taking the blood thinner alone, Davidson said.

Read more:

Heartburn meds thwart blood thinner
Retrospective study found blood thinners associated with 50% cut in death rate


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