Key result
Adding NSAIDs to warfarin is linked to ~98% higher GI bleeding risk versus warfarin alone.
Why the study?
Warfarin can trigger bleeding independently or through drug-drug interactions when combined with NSAIDs, prompting an evaluation of bleeding risk with concomitant use versus warfarin alone.
Does concomitant use of warfarin and NSAIDs increase the risk of bleeding compared to warfarin alone in individuals taking warfarin?
Meta-Analysis
Does concomitant use of warfarin and NSAIDs increase the risk of bleeding compared to warfarin alone in individuals taking warfarin?
Concomitant use of warfarin and NSAIDs or COX-2 inhibitors significantly increases the risk of gastrointestinal and general bleeding compared to warfarin alone.
Answers are grounded in this paper and cite their sources.
Warrants avoiding or closely monitoring NSAID co-prescription with warfarin; confirms the GI bleeding interaction in pooled data.
BACKGROUND: Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug-drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). OBJECTIVES: This article examines the risk of bleeding in individuals exposed to concomitant warfarin and NSAID compared with those taking warfarin alone (Prospero Registry ID 145237). METHODS: . Risk of bias was also assessed using the Agency for Healthcare Research and Quality bias assessment tool. RESULTS: A total of 651 studies were identified, of which 11 studies met inclusion criteria for meta-analysis. The odds ratio (OR) for gastrointestinal bleeding when exposed to warfarin and an NSAID was 1.98 (95% confidence interval [CI]: 1.55-2.53). The risk of gastrointestinal bleeding was also significantly elevated with exposure to a COX-2 inhibitor and warfarin relative to warfarin alone (OR = 1.90, 95% CI: 1.46-2.46). There was an increased risk of general bleeding with the combination of warfarin with NSAIDs (OR = 1.58, 95% CI: 1.18-2.12) or COX-2 inhibitors (OR = 1.54, 95% CI: 0.86-2.78) compared with warfarin alone. CONCLUSION: Risk of bleeding is significantly increased among persons taking warfarin and a NSAID or COX-2 inhibitor together as compared with taking warfarin alone. It is important to caution patients about taking these medications in combination.
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Zapata et al. (2020) conducted a meta-analysis in Patients requiring warfarin therapy. Warfarin and NSAID vs. Warfarin alone was evaluated on Gastrointestinal bleeding (OR 1.98, 95% CI 1.55-2.53, p=<0.001). Concomitant use of warfarin and an NSAID significantly increased the risk of gastrointestinal bleeding compared to taking warfarin alone (OR 1.98).
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