• Posted November 18, 2024

Certain Painkillers Can Raise Bleeding Risks for People on Blood Thinners

People on blood thinners have a doubled risk of dangerous internal bleeding if they also take a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen, a new study warns.

People typically are prescribed blood thinners to treat or prevent strokes, heart attacks, or blood clots in the legs or lungs, researchers said.

NSAIDs also are known to thin the blood, and the new study shows that they can increase risk of uncontrolled bleeding in the gut, brain, lungs and bladder if taken alongside a blood thinner.

“We found that for patients taking blood thinners for blood clots in the legs or lungs, using NSAIDs doubled the risk of bleeding compared with not using NSAIDs,” said researcher Soren Riis Peterson, a medical student with Aarhus University Hospital in Denmark. “The increased bleeding risk associated with NSAID use was not limited to the digestive tract but also seemed to affect other organ systems.”

For the study, researchers analyzed data on nearly 52,000 Danish patients prescribed a blood thinner to treat a blood clot between 2012 and 2022.

In Denmark, the NSAIDs diclofenac and naproxen can only be obtained through a prescription. This allowed researchers to track the health of patients who had been prescribed both a blood thinner and an NSAID.

Overall, the risk of a bleed was two times higher when people took a blood thinner and an NSAID, compared to just taking a blood thinner, researchers found.

The specific risk was four times higher for naproxen, three times higher for diclofenac and nearly twice as high for ibuprofen.

Specific bleed risks included:

• 2.2 times higher risk of a gut bleed

• 3.2 times higher risk of a brain bleed

• 1.4 times higher risk of a lung bleed

• 1.6 times higher risk of a urinary tract bleed

Using NSAIDs with a blood thinner also tripled a person’s risk of anemia, researchers found.

The pattern of risk remained similar across a wide variety of blood thinners, including rivaroxaban, apixaban, dabigatran, edoxaban and warfarin, results show.

The new study was published Nov. 17 in the European Heart Journal.

“For people taking blood thinners for blood clots in their legs or lungs, our research highlights the importance of being cautious when considering NSAIDs for pain or inflammation,” Petersen concluded in a journal news release. “We recommend that patients consult their doctor before taking NSAIDs along with a blood thinner.”

In an accompanying editorial, Dr. Robert Storey, a professor of clinical cardiology with the University of Sheffield in the U.K., noted that NSAIDs are widely used, making up about 8% of prescriptions worldwide and often available over-the-counter.

“It seems clear that avoiding NSAIDs in combination with [blood thinners] is the safest strategy to avoid excess bleeding risk,” Storey wrote. “However, if this is not possible, what mitigation can be put in place? NSAID prescription should obviously be at the lowest dose and for the shortest time possible, but choice of agent and route may also be important.”

More information

The Cleveland Clinic has more on blood thinners.

SOURCE: European Society of Cardiology, news release, Nov. 17, 2024