Concomitant Oral Anticoagulant and Nonsteroidal Anti-Inflammatory Drug Therapy in Patients With Atrial Fibrillation

Journal of the American College of Cardiology
Anthony P KentMichael D Ezekowitz

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used medications that can potentially increase the risk of bleeding and thrombosis. This study quantified the effect of NSAIDs in the RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial. This was a post hoc analysis of NSAIDs in the RE-LY study, which compared dabigatran etexilate (DE) 150 and 110 mg twice daily (b.i.d.) with warfarin in patients with atrial fibrillation. Treatment-independent, multivariate-adjusted Cox regression analysis assessed clinical outcomes by comparing NSAID use with no NSAID use. Interaction analysis was obtained from treatment-dependent Cox regression modeling. Time-varying covariate analysis for NSAID use was applied to the Cox model. Among 18,113 patients in the RE-LY study, 2,279 patients used NSAIDs at least once during the trial. Major bleeding was significantly elevated with NSAID use (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.40 to 2.02; p < 0.0001). NSAID use did not significantly alter the risk of major bleeding for DE 150 or 110 mg b.i.d. relative to warfarin (pinteraction = 0.63 and 0.93, respectively). Gastrointestinal major bleeding was significantly elevated with NSAID use (HR: 1.81; 95% CI: 1....Continue Reading

Citations

Sep 12, 2019·Clinical Pharmacology and Therapeutics·Joris J KomenTomas Forslund
Apr 11, 2020·Clinical Pharmacology and Therapeutics·Meijia ZhouSean Hennessy
Jul 14, 2020·Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation·Hawa O AbuDavid D McManus
Mar 12, 2020·Cardiovascular Diabetology·Yi-Hsin ChanShih-Ann Chen
Sep 4, 2020·Yonsei Medical Journal·Min Taek LeeSun Young Jung
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Apr 21, 2021·Pain and Therapy·Alberto MagniDiego Fornasari
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Aug 12, 2021·Expert Opinion on Drug Safety·María-José Domper ArnalAngel Lanas

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