Certain drug combinations can be dangerous. If certain combinations are even formally contraindicated, others require monitoring for possible side effects. In this context, a recent Danish study looked at the increased risk of bleeding in patients taking an anticoagulant and a non-steroidal anti-inflammatory drug simultaneously. Explanations.
Anticoagulants associated with risk of bleeding
Anticoagulant medications are indicated in different emergency situations, for example during a cerebrovascular accident (CVA), in certain acute conditions such as phlebitis or to prevent recurrences or cardiovascular complications in patients suffering from chronic cardiovascular pathologies. Today, different classes of anticoagulant drugs are available, with different modes of action, durations of action and therapeutic indications, but all of these drugs aim to limit the formation of blood clots.
Given their effect on blood clotting, all anticoagulant drugs increase the risk of hemorrhagealthough some are associated with a higher bleeding risk than others. This side effect explains why patients on anticoagulants must avoid certain risky situations:
- Domestic accidents (a fall, an injury);
- The practice of violent sports.
Likewise, precautions are necessary when carrying out certain treatments (such as dental care) or during surgery.
The risk of bleeding more than doubles when taking an NSAID
Can this bleeding risk of anticoagulants be increased by the combination with other medications? For several years, researchers and doctors have been pointing the finger nonsteroidal anti-inflammatory drugs (NSAIDs)medications widely used in the treatment of fever, inflammation and/or mild to moderate pain. Studies have suggested an increased risk of bleeding when an anticoagulant is combined with an NSAID.
To better decipher the impact of this drug interaction, Danish researchers conducted a study between 2012 and 2022 on 51,794 patients under treatment with an oral anticoagulant after a thromboembolic accident. The data collected showed that taking NSAIDs during anticoagulant treatment could more than double the risk of internal bleeding. This risk was found for various commonly used NSAIDs, some of which are available without a medical prescription.
No self-medication with anticoagulants…
If the external hemorrhages are generally more quickly detected by the patient, for example nosebleeds, internal bleeding can go unnoticed even though they are potentially serious. In the association between NSAIDs and anticoagulants, researchers observed an increase in the risk of internal bleeding at several levels:
- At the intestinal level;
- At the level of the lungs;
- At the cerebral level;
- At the level of the bladder.
These hemorrhages can be serious in terms of their intensity (i.e. depending on the volume of blood lost) and/or their duration (certain digestive hemorrhages can become chronic). Both patients and healthcare professionals must monitor the signs of internal bleeding: presence of blood in urine or stools, coughing up blood, signs of anemia, but also signs of severity of the bleeding:
- Rapid breathing;
- A bluish discoloration of the extremities associated with coldness;
- Marbling on the limbs;
- An irregular pulse;
- Disorders of consciousness;
- A commotion.
Such signs of seriousness require emergency hospitalization.
This new study confirms the increased risk of bleeding by combining NSAIDs and anticoagulants. A risk that can be controlled by not taking any medication without the advice of a healthcare professional! Alternatives exist to avoid combining anticoagulants and NSAIDs.
Sources
– S.R. Petersen, et al. 2024. Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study. European Heart Journal. Ehae 736. academic.oup.com. Consulté le 12 décembre 2024.
– Health insurance. Anticoagulants: importance of monitoring during treatment. October 24, 2024. . www.ameli.fr. Accessed December 12, 2024.
