NSAIDs Plus Anticoagulants a Dangerous Combination for Atrial Fibrillation- RE-LY Trial

Concomitant use of oral anticoagulants and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with atrial fibrillation (AF) elevates the risk for major bleeding, stroke, and hospitalization, according to the results of the RE-LY trial published in the Journal of the American College of Cardiology.

Nonselective NSAIDs, including ibuprofen, naproxen, meloxicam, diclofenac, and ketorolac, all have the ability to increase the risk for bleeding and were included in the RE-LY trial.

Anthony P. Kent and his associates conducted a study to quantify the effect of NSAIDs in the RE-LY (Randomized Evaluation of Long-Term Anticoagulant Therapy) trial.

The researchers conducted 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. The study included 18,113 patients in the RE-LY study out of which 2,279 patients used NSAIDs at least once during the trial.

The study found that:

• Major bleeding was significantly increased with NSAID.


• NSAID use did not significantly alter the risk of major bleeding for DE 150 or 110 mg b.i.d. relative to warfarin


• Gastrointestinal major bleeding was significantly elevated with NSAID.


• The rate of stroke or systemic embolism (stroke/SE) with NSAID use was significantly elevated.


• The use of NSAIDs did not significantly alter the relative efficacy on stroke/SE for DE 150 or 110 mg b.i.d. relative to warfarin


• Myocardial infarction rates were similar with NSAID use compared with no NSAID use.


• Patients were more frequently hospitalized if they used an NSAID

The study concluded that the use of NSAIDs was linked to increased risk of major bleeding, stroke/SE, and hospitalization and the safety and efficacy of DE 150 and 110 mg b.i.d. relative to warfarin was not altered.

Atrial fibrillation is an irregular and often rapid heart rate that can increase your risk of stroke, heart failure, and other heart-related complications.

For reference log on to http://www.onlinejacc.org/content/72/3/255