Could NSAIDs Increase Bleeding Risk in Patients With AF?

In patients with atrial fibrillation (AF), nonsteroidal anti-inflammatory drug (NSAID) use increased the risk for bleeding and thromboembolism, according to a recent study.

For the study, researchers monitored 150,900 participants newly diagnosed with AF and used Cox models to assess the absolute risk of thromboembolism and bleeding associated with ongoing antithrombotic therapy and NSAID use.  During a median follow-up period of 6.2 years, 35.6% were prescribed an NSAID.
_________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Can NSAIDs Increase VTE Risk?
High-Dose NSAIDs Increase Risk of Cardiovascular Events
_________________________________________________________________________________________________________________________________________________________________

After 3 months, researchers noted an increased risk for serious bleeding within 14 days of exposure to NSAIDs; their findings showed 3.5 events per 1000 participants compared to 1.5 events per 1000 patients who were using NSAIDs.

Further, investigators noted an increased risk for thromboembolism and serious bleeding when NSAIDS were taken with an oral anticoagulant, or an antiplatelet, or both. However, patients yielded heightened risks when they took NSAIDS alone.

“Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding,” concluded the study’s authors.

The complete study is published in the November issue of Annals of Internal Medicine.

-Michelle Canales

Reference:

1. Lamberts M, Lip GYH, Hansen ML, et al. Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy: a nationwide cohort study. Ann Intern Med. 2014 November [epub ahead of print] doi: 10.7326/M13-1581.