Study Provides Insights on NSAIDs Double Internal Bleeding Risk in Patients on Anticoagulants - Video

People who take an anticoagulant medicine double their risk of an internal bleed if they take a type of painkiller called a non-steroidal anti-inflammatory drug such as ibuprofen, diclofenac or naproxen, according to research published in the European Heart Journal.

The new study is the largest of its kind and shows that there is an increase in the risk of bleeding in the gut, brain, lungs and bladder. The research was carried out by a team from Aarhus University Hospital in Denmark. They used data from Danish nationwide registries on 51,794 people given anticoagulants to treat a blood clot between 2012 and 2022.

The researchers found that the risk of a bleed was 2.09 times higher when people were taking an NSAID and a blood thinner, compared to those taking a blood thinner and no NSAID. The risk for ibuprofen was 1.79 times higher, for diclofenac the risk was 3.3 times higher and for naproxen, the risk was 4.1 times higher.

The risk of a bleed in the gut with NSAID use was 2.24 times higher. The risk of a bleed in the brain was 3.22 times higher. In the lungs, the risk of a bleed was increased by 1.36 times. In the urinary tract, the risk of a bleed was 1.57 times higher. There was also almost a tripling of the risk of anaemia caused by bleeding.

The researchers looked at several types of blood thinners – including rivaroxaban, apixaban, dabigatran, edoxaban and warfarin – and found a similar pattern of risk.

The study’s author, Mr Søren Riis Petersen, from Aarhus University Hospital, said: “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. The increased bleeding risk associated with NSAID use was not limited to the digestive tract but also seemed to affect other organ systems. “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. We recommend that patients consult their doctor before taking NSAIDs along with a blood thinner.”

Reference: Søren Riis Petersen, Kasper Bonnesen, Erik Lerkevang Grove, Lars Pedersen, Morten Schmidt, Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study, European Heart Journal, 2024;, ehae736, https://doi.org/10.1093/eurheartj/ehae736