Blood thinners and NSAIDs...The Increased Risk of Bleading

The risk of major bleeding is well documented while taking blood thinners such as: Warfarin; novel anti-coagulants such as  Pradaxa, Xarelto and Eliquis; aspirin; and other NSAIDs such as advil and Motrin. One of the easiest ways to picture this is to think of you blood like this. If you spill a creamier salad dressing verses an Italian salad dressing, obviously, the bottle of Italian dressing will be empty before the bottle of the creamier dressing such as ranch is empty. When a person is on blood thinners, the person's blood is less viscous (less thick) compared to a person not on blood thinners. 

There was a study conducted which was recently published in JAMA in June of 2014 which set out
"[t]o estimate the bleeding risk of combined anticoagulant (rivaroxaban or enoxaparin–vitamin K antagonist [VKA]) and NSAID or aspirin therapy in patients with venous thromboembolism."  In plain english, that means to determine the risk of a major bleed like a stroke or stomach bleed while on these medicines or a combination of these medicines.

In a blog post linked to here, the lead author, Bruce L. Davidson, M.D., discusses the findings. Some of the major findings were that if people are taking anticoagulant medications such as Xarelto, Lovenox, or Warfarin, and are additionally taking an NSAID, they are 2.5 times as likely to suffer a major bleed than if they are just taking the anti-coagulant medication alone. The risk of taking aspirin together with an anticoagulant raised the risk of a major bleed by 1.5 times compared to taking the anticoagulant alone.  Also, almost a quarter of the bleeds happened within 8 days of starting the NSAID.

Dr. Davidson is also quoted there saying that many people could take Tylenol instead of an NSAID for everyday aches and pains while on anticoagulant medications. 

Major Public Health Implication: If people taking anticoagulant medications  would be encouraged to take tylenol instead of NSAIDs for minor problems like colds and sore throats, many major bleeds could be prevented, lives saved, and many healthcare dollars saved.