Arrhythmias & electrophysiology
Bleeding risk using non-steroidal anti-inflammatory drugs in anticoagulated patients with atrial fibrillation: a nationwide cohort study
Authors' conclusion
NSAID use was associated with a nearly two-fold increase in hospital-diagnosed bleeding among patients with AF receiving oral anticoagulation. The risk appeared highest with edoxaban, followed by apixaban and rivaroxaban, and lowest with dabigatran and warfarin. The risk was not restricted to the gastrointestinal tract.
Study context
- Population
- Patients with first-time diagnosed atrial fibrillation (AF) who initiated oral anticoagulation during 2012–22
- Participants
- 114,119 patients
- Exposure
- NSAID use vs non-use
- Outcome
- Hospital-diagnosed bleeding events per 100 person-years
Main finding
As reported in the abstract
- Number needed to harm (patients treated for 1 year)
- 43
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| Hospital-diagnosed bleeding by siteNSAID use vs non-use · bleeding overall · Time-dependent multivariate cause-specific Cox regression | 1.81 (1.59–2.06) | |
| Hospital-diagnosed bleeding by siteNSAID use vs non-use · gastrointestinal bleeding · Time-dependent multivariate cause-specific Cox regression | 2.30 (1.92–2.76) | |
| Hospital-diagnosed bleeding by siteNSAID use vs non-use · thoracic/respiratory tract bleeding · Time-dependent multivariate cause-specific Cox regression | 1.59 (1.13–2.24) | |
| Hospital-diagnosed bleeding by siteNSAID use vs non-use · urinary tract bleeding · Time-dependent multivariate cause-specific Cox regression | 1.48 (1.17–1.88) | |
| Hospital-diagnosed bleeding by siteNSAID use vs non-use · anaemia caused by bleeding · Time-dependent multivariate cause-specific Cox regression | 3.50 (2.33–5.26) | |
| Bleeding by anticoagulantNSAID use vs non-use · rivaroxaban | 2.05 (1.64–2.57) | |
| Bleeding by anticoagulantNSAID use vs non-use · apixaban | 2.15 (1.70–2.72) | |
| Bleeding by anticoagulantNSAID use vs non-use · dabigatran | 1.40 (0.92–2.13) | |
| Bleeding by anticoagulantNSAID use vs non-use · edoxaban | 2.87 (1.26–6.53) | |
| Bleeding by anticoagulantNSAID use vs non-use · warfarin | 1.46 (1.07–1.98) | |
| 0.10.31310Adjusted hazard ratio (log scale) |
NSAID subtypes
- Results were consistent across NSAID subtypes.
Original publication
Bleeding risk using non-steroidal anti-inflammatory drugs in anticoagulated patients with atrial fibrillation: a nationwide cohort study. Eur Heart J Qual Care Clin Outcomes. Published 5 August 2025. doi:10.
Summarised from the published abstract; every number is checked against it