Nonsteroidal anti-inflammatory drugs and bleeding risk in anticoagulated patients with atrial fibrillation

Abstract

Although nonsteroidal anti-inflammatory drugs (NSAIDs) have generally conferred increased gastrointestinal bleeding risk, the data for bleeding risks with these drugs in anticoagulated atrial fibrillation (AF) patients per se were much more limited. Recent evidence shows that concomitant use of NSAIDs in anticoagulated AF patients carries a real risk of serious bleeding, as well as thromboembolism. Thus, physicians should clearly exercise extra caution with NSAIDs in patients with AF, especially if they are anticoagulated. Also, AF patients with NSAIDs should also undergo regular clinical review, and clinicians should regularly reassess the need for NSAID use. Finally, as a part of regular clinical assessment, bleeding risk should be routinely assessed, and the HAS-BLED score is now recommended in many guidelines for this purpose.

Keywords:

• aspirin
• atrial fibrillation
• bleeding
• NSAID
• warfarin

Financial & competing interests disclosure

GYH Lip has served as a consultant for Bayer, Merck, Sanofi, BMS/Pfizer, Daiichi-Sankyo, Biotronik, Medtronic, Portola and Boehringer Ingelheim and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo and Medtronic. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.