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Concomitant coumarin-NSAID therapy and risk for bleeding
Ellen A J Knijff-Dutmer1, Gelte A Schut, Martin A F J van de Laar
1Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands. eajkniff@hotmail.com
The Annals of Pharmacotherapy
|December 31, 2002
Summary
Combining nonsteroidal anti-inflammatory drugs (NSAIDs) with coumarin derivatives significantly increases bleeding risk. This study found NSAID use in coumarin patients led to a 5.8-fold higher risk of bleeding complications.
Area of Science:
- Pharmacology
- Clinical Medicine
- Drug Safety
Background:
- Coumarin derivatives are widely prescribed anticoagulants.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are common analgesics and anti-inflammatories.
- Concurrent use of these drug classes raises concerns about bleeding complications.
Purpose of the Study:
- To quantify the risk of bleeding associated with the combined use of coumarin derivatives and NSAIDs.
- To compare this risk against the use of coumarin derivatives alone.
Main Methods:
- A 1-year observational study involving an outpatient anticoagulation office and local pharmacists.
- Data collection through questionnaires for patients with bleeding complications and prescription records for concomitant users.
- Estimation of the relative risk for bleeding due to combined NSAID and coumarin use.
Main Results:
- 738 hemorrhages were identified in 681 coumarin users over 1 year.
- NSAIDs were involved in 12.2% of bleeding cases, while only 2.5% of all coumarin users were prescribed NSAIDs.
- The relative risk of bleeding complications with concomitant NSAID use was 5.8 (95% CI 2.3 to 13.6).
Conclusions:
- Concomitant use of NSAIDs and coumarin derivatives substantially elevates bleeding risk.
- Despite frequent co-prescription, the findings strongly support contraindicating the combined use of these medications.