Is it dangerous to combine NSAIDs with blood thinning drugs?

This study investigated the safety of non-steroidal anti-inflammatory drugs (NSAIDs) in combination with blood-thinning drugs such as dabigatran (Pradaxa) or warfarin (Coumadin) in people with atrial fibrillation (AF; abnormal heart rhythm). It was determined that using NSAIDs increased the risk of bleeding and strokes in people with AF receiving dabigatran or warfarin.

NSAIDs, such as ibuprofen and naproxen, are medications that are commonly used to treat pain. However, they have been associated with an increased risk of bleeding and blood clots. Dabigatran and warfarin are medications used to prevent the formation of blood clots in people with AF. However, combining NSAIDs with dabigatran or warfarin may significantly increase the risk of bleeding.

18,113 adults with AF participated in this study. They were randomly divided into 3 groups. Two groups received different doses of dabigatran. The other group received warfarin. 2,279 participants used NSAIDs at least once during the trial. They were followed up for an average of 2 years for the development of complications.

Participants who used NSAIDs were 63% more likely to develop any bleeding, and 68% more likely to develop major bleeding than those who did not. The risk of major bleeding from the stomach and intestines was 81% higher in patients who used NSAIDs. They were also 64% more likely to be hospitalized than patients who did not use NSAIDs.

Participants who used NSAIDs were 50% more likely to have a stroke than those who did not. The use of NSAIDs did not affect the risk of heart attacks or mortality. The effects of dabigatran compared to warfarin were not affected by the use of NSAIDs. 

The study concluded that the use of NSAIDs in people with AF, who are receiving dabigatran or warfarin, increases the risk of bleeding and stroke, but not of heart attacks or mortality.

The researchers did not have data on the type of NSAID used, the dose of NSAID taken, or the reason for using an NSAID. This may have affected the results.

Discuss the use of NSAIDs with your physician.