Pain Relievers Posed Bleeding Risk for Some Patients

NSAIDs may raise bleeding risk in patients with atrial fibrillation

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) NSAIDs are often a go-to treatment for minor aches and pains. But patients with atrial fibrillation may want to have another talk with their doctor about whether these medications are the best option.

Patients who have a heart condition called atrial fibrillation may develop serious bleeding when they take nonsteroidal anti-inflammatory drugs (NSAIDs), a new study found.

The study authors said doctors should be cautious about prescribing NSAIDs and use alternate pain medications when possible.

"Most patients with a diagnosis of atrial fibrillation are prescribed blood thinning medications such as warfarin or one of the newer products such as Pradaxa, Xarelto or Eliquis," said E. Lee Carter, RPh, Clinical Pharmacy Specialist at the Department of Veterans Affairs in Prestonsbrug, Kentucky.

"It has long been understood that concurrent use of NSAIDs, which themselves have blood-thinning properties, can produce additional thinning and therefore lead to bleeding issues," said Carter, who was not involved in this study.

"This new study sheds further light on the possible consequences of using NSAIDs in patients with AFib," he said. "Patients looking for an over-the-counter pain reliever should always check first with their doctor or pharmacist to ensure that these products will not interact with their current medical conditions or medications."

Morten Lamberts, MD, PhD, of Gentofte University Hospital in Hellerup, Denmark, led this recent study. The researchers wanted to examine the risks of NSAID use in patients who have atrial fibrillation.

Atrial fibrillation causes an abnormal heartbeat. It can result in blood clots inside the heart that can be pumped into the brain and cause a stroke.

To reduce the risk of stroke, doctors may prescribe an anticoagulant medication (blood thinner) that makes the blood less likely to clot. Warfarin (brand name Coumadin) is a common anticoagulant. Heparin is another anticoagulant.

NSAIDs are a class of medications often used for minor pains like headaches. Some NSAIDs — such as naproxen (brand names Aleve and Naprosyn) and ibuprofen (Advil, Midol and Motrin) — can be purchased without a prescription. NSAIDs are known to increase the risk of bleeding because they prevent blood clotting.

The authors studied whether patients had been hospitalized for serious bleeding or blood clots. They found that 17,187 patients — or 11.4 percent of the patients in the study — had been hospitalized for bleeding. Also, 19,561 — 13 percent of the patients — were hospitalized for blood clots.

Patients who had received NSAIDs were almost twice as likely as the patients who didn't take NSAIDs to develop serious bleeding. For every 1,000 patients who took NSAIDs, 3.5 had bleeding — compared to 1.5 out of each 1,000 patients who did not take NSAIDs.

Of atrial fibrillation patients who were also on anticoagulants, 2.5 out of every 1,000 patients who took NSAIDs developed serious bleeding.

The researchers also found that the bleeding risk was high no matter what type of NSAID and anticoagulant the patient used. However, a higher NSAID dose appeared to increase the risk of bleeding.

Even patients who only used NSAIDs for a short period — up to 14 days — were more likely to develop serious bleeding than patients who did not use NSAIDs.

Dr. Lamberts and team found that two medications — naproxen and diclofenac  — were much more likely to cause serious bleeding than other NSAIDs.

"These results suggest that physicians should exercise caution when prescribing any NSAIDs in patients with atrial fibrillation receiving [blood-thinning medications] and should choose safer alternative [pain medications] when possible,” the study authors wrote.

Dr. Lamberts and colleagues studied data on 150,900 Danish patients who had been diagnosed with atrial fibrillation for the first time. The data was from 1997 to 2011.

Patients ranged in age from 65 to 83 years old. Fifty-three percent of the patients were male, and 47 percent were female.

This study was published Nov. 17 in Annals of Internal Medicine.

The authors disclosed no funding sources for the research. The Novo Nordisk Foundation funded one of the study authors, Dr. Gunnar H. Gislason, with an unrestricted research scholarship.

Review Date: 
November 17, 2014
Last Updated:
November 24, 2014