This Rx Combo Could Raise Risks After Heart Attack

NSAIDs taken with anti-clotting medications after heart attack could raise heart risks

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

(RxWiki News) Some things just don’t go together. NSAIDs and anti-clotting medications may be among those things.

A new study advised that patients taking medications to stop blood clots from forming after a heart attack should avoid using NSAIDs. Taking anti-clotting medications and NSAIDs at the same time was linked to a higher risk of bleeding and other heart issues, this study found. Even short-term use of NSAIDs taken with anti-clotting medications may result in heart events like stroke or another heart attack.

“These [heart] risks are of considerable public health concern, given the widespread use of NSAIDs,” wrote lead study author Anne-Marie S. Olsen, MD, PhD, of Copenhagen University Hospital in Hellerup, Denmark, and colleagues.

Heart diseases due to blood clots include heart attacks, stroke, and other forms of blood flow blockage that may cause death. That’s why current guidelines recommend that all heart attack patients be given antithrombotic therapy, which prevents the forming of blood clots. Anti-clotting therapy includes aspirin and clopidogrel (trade name Plavix).

Sometimes, patients take nonsteroidal anti-inflammatory drugs (NSAIDs) to ease the pain from heart attacks or other heart issues. Dr. Olsen and team found that the bleeding risks linked to anti-clotting medications increased when patients also took NSAIDs. Certain NSAIDs, such as ibuprofen, blocked the anti-clotting effects of aspirin and raised the risk of heart issues.

Nearly 62,000 patients (68 years old on average) were studied. From this group of patients, 34 percent used at least one NSAID. After about 3.5 years of follow-up, just over 18,000 of these patients (29 percent) had died. Among these, around 5,000 bleeding events and more than 18,000 heart issue events occurred during this study.

Dr. Olsen and team noted that NSAID treatment along with anti-clotting treatment was tied to about two times the risk of bleeding without NSAID treatment. The risk of other heart issues also went up with NSAID use compared to no NSAID use.

In an editorial about this study, Charles L. Campbell, MD, of the University of Tennessee in Chattanooga, and David J. Moliterno, MD, of the University of Kentucky in Lexington, noted that this study only looked at prescription NSAIDs.

"Because the present study tracked only prescription NSAID use, it is plausible that an even greater health care effect might occur in many countries, such as the United States, where NSAIDs are widely available as over-the-counter medications and physicians may be unaware whether their patients are taking NSAIDs," Drs. Campbell and Moliterno wrote.

The study and editorial were published Feb. 24 in JAMA.

The Danish Council for Independent Research funded this study. Study author Dr. Christian Torp-Pedersen received funds from various pharmaceutical companies.

Review Date: 
February 25, 2015
Last Updated:
February 27, 2015