Study Highlights Elevated Bleeding Risks When Combining Anticoagulants with NSAIDs

(IN BRIEF) Research published in the European Heart Journal reveals that combining anticoagulants with NSAIDs, such as ibuprofen, diclofenac, or naproxen, significantly increases the risk of internal bleeding. The study, involving over 51,000 patients in Denmark, found that the bleeding risk is more than doubled, with specific risks varying by NSAID type. For example, diclofenac raised the risk by 3.3 times, while naproxen increased it by 4.1 times. Bleeding risks were observed across multiple organs, including the gut, brain, lungs, and urinary tract. Experts recommend avoiding NSAIDs when on anticoagulants or using the lowest effective dose for the shortest time, alongside exploring alternative pain management methods to mitigate risks.

(PRESS RELEASE) SOPHIA ANTIPOLIS, 19-Nov-2024 — /EuropaWire/ — A new study published in the European Heart Journal reveals that patients taking anticoagulants, such as rivaroxaban or warfarin, face a significantly increased risk of internal bleeding when also using non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, diclofenac, or naproxen. Conducted by researchers from Aarhus University Hospital in Denmark, the study is the largest of its kind, analyzing data from over 51,000 individuals treated for blood clots between 2012 and 2022.

Key Findings

The research showed that using NSAIDs alongside blood thinners more than doubles the risk of internal bleeding compared to using anticoagulants alone.

The risks vary by type of NSAID:

Ibuprofen: 1.79 times higher risk of bleeding.
Diclofenac: 3.3 times higher risk.
Naproxen: 4.1 times higher risk.

The study highlighted that the bleeding risk spans multiple organ systems:

Gut bleeding: 2.24 times higher risk.
Brain bleeding: 3.22 times higher risk.
Lung bleeding: 1.36 times higher risk.
Urinary tract bleeding: 1.57 times higher risk.
Additionally, the risk of anemia due to bleeding nearly tripled when NSAIDs were used.

Context and Implications

Anticoagulants are vital for treating venous thromboembolism (VTE), which affects about one in 12 people and includes conditions such as deep vein thrombosis and pulmonary embolism. NSAIDs, meanwhile, are widely used for pain and inflammation, both via prescription and over-the-counter sales.

According to lead author Søren Riis Petersen from Aarhus University Hospital, “Our findings emphasize the importance of caution when considering NSAIDs for patients on blood thinners. These medications can significantly increase bleeding risks beyond the digestive system, affecting multiple organs. Patients should consult their doctor before combining these drugs.”

Recommendations and Expert Insights

In an accompanying editorial, Professor Robert F. Storey of the University of Sheffield stressed the importance of mitigating risks for patients requiring both types of medication. He emphasized using NSAIDs sparingly, at the lowest dose and for the shortest duration possible, while exploring alternative pain management methods, including non-pharmacological therapies.

Storey added, “Anticoagulation is essential for treating VTE, but clinicians must carefully evaluate all bleeding risk factors, including NSAID use, and counsel patients on safer options.”

Broader Impact

Given the widespread use of NSAIDs—accounting for 8% of global prescriptions—this study underscores the need for greater awareness among both healthcare providers and patients. As anticoagulants are increasingly prescribed for long-term use, understanding and mitigating these risks is crucial to reducing potentially severe outcomes, such as major disability or even death.

Funding: the Novo Nordisk Foundation, and the Danish Diabetes and Endocrine Academy

Disclosures: None

References

[1] ‘Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study’, by S.R. Petersen et al, https://doi.org/10.1093/eurheartj/ehae736

[2] ‘Oral anticoagulation and non-steroidal anti-inflammatory drugs: a recipe for bleeding’, by W.A.E. Parker et al, https://doi.org/10.1093/eurheartj/ehae795

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

The European Heart Journal is the flagship journal of the European Society of Cardiology. It is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press.

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SOURCE: European Society of Cardiology (ESC)

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