Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study

doi:10.1093/eurheartj/ehae736

Pulmonary vascular disease & thromboembolismCohort study

Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study

Eur Heart JPublished 18 Nov 2024

Nationwide cohort study
time-dependent cause-specific Cox regression

Read the original article ↗

Authors' conclusion

Patients treated with oral anticoagulants for VTE had a more than two-fold increased bleeding rate when using NSAIDs. This increased bleeding rate was not restricted to the gastrointestinal tract.

Study context

Population: Patients with venous thromboembolism (VTE) initiating oral anticoagulants, Denmark, 2012–2022
Participants: 51,794 patients

Exposure: NSAID use vs non-use during oral anticoagulation
Outcome: Hospital-diagnosed bleeding (any bleeding)

Main finding

As reported in the abstract

Any bleeding

Non-use3.595% CI 3.4–3.7 · per 100 person-years

NSAID use6.395% CI 5.1–7.9 · per 100 person-years

NSAID use vs Non-useAdjusted hazard ratio (95% CI)

overall

2.09(1.67–2.62)

ibuprofen

1.79(1.36–2.36)

diclofenac

3.30(1.82–5.97)

naproxen

4.10(2.13–7.91)

NNH (patients treated for 1 year): 36

Observational data: associations, not effects.

Further findings

Outcome	Lower risk with NSAID use ←→ Higher risk with NSAID use	adjusted HR (95% CI)
Bleeding by site — NSAID use vs Non-use · gastrointestinal bleeding		2.24 (1.61–3.11)
Bleeding by site — NSAID use vs Non-use · intracranial bleeding		3.22 (1.69–6.14)
Bleeding by site — NSAID use vs Non-use · anaemia caused by bleeding		2.99 (1.45–6.18)
	0.10.31310Adjusted hazard ratio (log scale)

Outcome	adjusted HR (95% CI)
Bleeding by site — NSAID use vs Non-use · thoracic and respiratory tract bleeding	1.36 (.67-2.77)
Bleeding by site — NSAID use vs Non-use · urinary tract bleeding	1.57 (.98-2.51)

Anticoagulant and VTE subtypes

Results consistent for anticoagulant and VTE subtypes

Original publication

Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study. Eur Heart J. Published 18 November 2024. doi:10.1093/eurheartj/ehae736

Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it