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A new study found that people who use blood thinners have a double risk of internal bleeding if they also take non-steroidal anti-inflammatory drugs (NSAID) like ibuprofen or naproxen which are commonly known as painkillers. The study was published in the European Heart Journal.

Researchers said that people are usually prescribed blood thinners to treat or prevent strokes, heart attacks or blood clots in the legs or lungs. NSAIDs, on the other hand, are also known to thin the blood.

The new study shows that NSAIDs can increase the risk of uncontrolled bleeding in the gut, brain, lungs and bladder if taken alongside a blood thinner, according to a report in U.S. News.

Researcher Soren Riis Peterson, a medical student with Aarhus University Hospital in Denmark said, “We found that for patients taking blood thinners for blood clots in the legs or lungs, using NSAIDs doubled the risk of bleeding compared with not using NSAID.

“The increased bleeding risk associated with NSAID use was not limited to the digestive tract but also seemed to affect other organ systems.”

For the study, the researchers analysed data on nearly 52,000 Danish patients prescribed a blood thinner to treat a blood clot between 2012 and 2022. In Denmark, the NSAIDs diclofenac and naproxen can only be obtained through a prescription. This allowed researchers to track the health of patients who had been prescribed both a blood thinner and an NSAID.

The researchers found that overall, the risk of a bleed was two times higher when people took a blood thinner and an NSAID, compared to just taking a blood thinner. The specific risk was four times higher for naproxen, three times higher for diclofenac and nearly twice as high for ibuprofen.

The study found the specific bleed risks which include; 2.2 times higher risk of a gut bleed, 3.2 times higher risk of a brain bleed, 1.4 times higher risk of a lung bleed and 1.6 times higher risk of a urinary tract bleed.

The study also found that using NSAIDs with a blood thinner also tripled a person’s risk of anaemia.

The pattern of risk remained similar across a wide variety of blood thinners, including rivaroxaban, apixaban, dabigatran, edoxaban and warfarin, results show.

Petersen in a journal news release concluded, “For people taking blood thinners for blood clots in their legs or lungs, our research highlights the importance of being cautious when considering NSAIDs for pain or inflammation.

“We recommend that patients consult their doctor before taking NSAIDs along with a blood thinner.”

Dr Robert Storey, a professor of clinical cardiology at the University of Sheffield in the U.K., in an accompanying editorial said, “It seems clear that avoiding NSAIDs in combination with [blood thinners] is the safest strategy to avoid excess bleeding risk.

“However, if this is not possible, what mitigation can be put in place? NSAID prescription should obviously be at the lowest dose and for the shortest time possible, but choice of agent and route may also be important.”

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