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Clinical Summary

Afib: NSAIDs use may need monitoring

Takeaway

  • Use of nonsteroidal anti-inflammatory drug (NSAIDs) was associated with significant risk for major bleeding, stroke/systemic embolism, and hospitalisation in patients with Afib.
  • NSAIDs did not affect the safety and efficacy of twice daily dabigatran etexilate 150 and 110 mg vs warfarin.

Why this matters

  • Caution should be exercised with NSAIDs use in patients with Afib who are receiving oral anticoagulants.

Study design

  • This post hoc analysis of RE-LY (Randomized Evaluation of Long-Term Anticoagulant Therapy) trial included 18,113 patients with Afib.
  • 2279 patients received NSAIDs at least once.
  • Funding: None.

Key results

  • NSAIDs use was associated with significantly higher risk for major bleeding (HR, 1.68; P<.0001) vs no use.
  • NSAIDs did not significantly alter the risk for major bleeding for dabigatran etexilate 110 and 150 mg vs warfarin (Pinteraction=.93 and .63, respectively).
  • Gastrointestinal major bleeding significantly increased with NSAIDs use (HR, 1.81; P<.0001).
  • NSAIDs increased the risk for stroke or systemic embolism (HR, 1.50; P=.007).
  • NSAIDs did not alter the efficacy of dabigatran etexilate 150 and 110 mg vs warfarin with respect to stroke/systemic embolism (Pinteraction=.59 and .54, respectively).
  • Risk for myocardial infarction was not statistically different between NSAIDs and no NSAIDs groups (HR, 1.22; P=.40).
  • NSAIDs use was associated with higher hospitalisation rates (HR, 1.64; P<.0001).

Limitations

  • Post hoc analysis.

References


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