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November 18, 2014 — The Annals of Internal Medicine has published a study linking the use of blood-thinning drugs plus popular painkillers may significantly increase a patient’s risk of bleeding and blood clots.

Non-Steroidal Anti-Inflammatory Drugs (NSAID) are painkillers like aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex).

Researchers decided to investigate the bleeding risk in patients with atrial fibrillation (abnormal heart rhythm) who were using an NSAID and a blood-thinning medication. Popular blood-thinners for AF include Plavix (clopidogrel), Pradaxa (dabigatran), Xarelto (rivaroxaban), and more.

Out of more than 150,000 people with atrial fibrillation, 35.6% were prescribed an NSAID. Over the next six years, 11.4% had serious bleeding and 13% developed blood clots.

The absolute risk was still small — bleeding occurred in 1.5 people for every 1,000 who did not take an NSAID, and 3.5 out of 1,000 who did use an NSAID.

NSAIDs and blood-thinners are well-known to increase bleeding risks, but they inhibit clotting on different pathways. Experts believe that 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].”

They also warn that in some cases, patients do not realize that they are taking an NSAID because they are often ingredients in over-the-counter products for cough, cold, flu, and minor pain.

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