November 18, 2014 — Combining common painkillers with blood-thinning drugs like Plavix (clopidogrel), Pradaxa (dabigatran), or Xarelto (rivaroxaban) could significantly increase the risk of bleeding and blood clots for people with atrial fibrillation, a type of irregular heart rhythm.
The Annals of Internal Medicine has published a study of over 150,000 people with atrial fibrillation.
About 35% of patients were prescribed a painkiller in the NSAID (non-steroidal anti-inflammatory drug) class. NSAIDs include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex).
Researchers found that 11.4% had serious bleeding and 13% developed blood clots during the six-year study. Major bleeding occurred in 3.5 out of 1,000 patients on an NSAID plus a blood-thinning medication, compared to 1.5 out of 1,000 who did not use an NSAID, which suggests the combination is more dangerous.
Researchers warned:
“Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with [atrial fibrillation]. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with [atrial fibrillation].”
Drugs in the NSAID class are well-known blood-thinners. It is not surprising that combining them with a different type of blood-thinner significantly increases a patient’s risk of bleeding. However, doctors continue to prescribe the combination, and patients may inadvertently take an NSAID in over-the-counter cough, cold, flu, and pain remedies.
In 2009, the New England Journal of Medicine published a study linking Plavix plus aspirin with a doubled risk of bleeding compared to patients on a placebo.
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