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.
“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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