May 12, 2018Basic & Clinical Pharmacology & Toxicology

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

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Why the study?

Does the co-administration of NSAIDs, particularly aspirin and COX-2 inhibitors, reduce warfarin control (TTR) and increase bleeding in patients on warfarin?

Structured PICO

Does the co-administration of NSAIDs, particularly aspirin and COX-2 inhibitors, reduce warfarin control (TTR) and increase bleeding in patients on warfarin?

Population

4,494 patients receiving warfarin therapy for atrial fibrillation (AF) or deep vein thrombosis (DVT) enrolled at a private pathology practice in Queensland, Australia. Mean age ~76 years, ~50% male. Dominating comorbidity was AF followed by hypertension.

Intervention

Co-administration of NSAIDs, subcategorized into aspirin, COX-2 selective inhibitors (celecoxib and meloxicam), and other NSAIDs.

Comparator

Patients on warfarin not taking NSAIDs.

Outcome

Warfarin control as measured by Time in Therapeutic Range (TTR) using the Rosendaal method, and bleeding events (major and minor).surrogate

Co-administration of aspirin with warfarin significantly reduces time in therapeutic range and increases minor bleeding events, highlighting the need for careful monitoring when these drugs are combined.

Limitations

Sub-analyses could not be performed in patients with good and poor control as only 13% of patients with no other interacting drugs had a TTR < 70%.
Lack of data on specific doses of warfarin and individual NSAIDs, which may have impacted TTR.

Discussion

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Implication

Aspirin co-use may reduce TTR; observational data leave open whether avoiding it improves control.

Cite This Study

Boyce et al. (2018) studied this question.

synapsesocial.com/papers/6a70536bac440176ef28fd1b https://doi.org/10.1111/bcpt.13037

Topics

Dual antiplatelet therapy Anticoagulation in AF

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Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider