A recent study has suggested that using NSAID painkillers with new generation blood thinners increases the chances of bleeding injuries. These painkillers include common over-the-counter products like Advil, Motrin, and Aleve, with the new blood thinning medications being Xarelto, Pradaxa, and Eliquis.

This study on NSAID and anticoagulant bleeding risks was conducted in Denmark from the Annals of Internal Medicine, and was published on Nov. 18, 2014. Conducting researchers found that patients being treated with blood thinners for atrial fibrillation had an increased likelihood of suffering bleeding injuries when using certain non-steroid anti-inflammatory drugs (NSAIDs).

The study analyzed approximately 150,900 patients with atrial fibrillation who were taking one of the new blood thinning medications and a NSAID drug. Data showed that within 14 days of taking a NSAID during their anticoagulant prescription, those patients were over twice as likely to suffer bleeding injuries than compared to patients who were not prescribed an NSAID.

The researchers stated that the findings did not relate to what type of NSAID drug was used, or which blood thinner the patients were taking. The study showed that the NSAID drugs increased the risk of certain blood-clot injuries as well, like deep vein thrombosis and pulmonary embolism.

Researchers explain that the results may have been affected by the dosage amount of the NSAID used, as in the more the painkillers were used, the more likely a bleeding event was to occur. This correlation of biological responses indicates a causal relationship. Essentially, this means that NSAIDs may increase the risk of thromboembolism events and may also increase the chances of internal bleeding with anticoagulants.

While NSAIDs have been associated with blood-clot injuries in the past, this study seems to show further evidence of this connection. The researchers concluded that NSAID painkillers and anticoagulants should most likely not be prescribed together, but no results have been conclusively proven.

New Anticoagulant Bleeding Concerns

This study adds to the concern surrounding the new-generation blood thinners, which have already been accused of causing severe and uncontrollable bleeding injuries in patients. Now, with the potential of an increased likelihood of bleeding injuries with NSAID painkillers, patients and physicians are now even more concerned by the possibilities.

Each of the new-generation anticoagulants — Pradaxa, Eliquis and Xarelto — are prescribed to treat patients with atrial fibrillation and are at a high risk for stroke, and were meant to be competitors to each other and to their predecessor, Warfarin.

Previously, Warfarin had been the default blood thinner prescribed to patients with certain blood-clot conditions. When it was prescribed it required frequent blood monitoring and dose adjustment, and even had a stopping agent in the case of internal bleeding injuries.

While the new-generation blood thinners Pradaxa, Xarelto, and Eliquis have been shown to work faster than Warfarin, and do not require blood monitoring or dosage adjustment, they do not have a reversal agent. While all blood thinning medications carry a bleeding risk, these factors make the risk much higher and more dangerous to the patients. In the case bleeding injuries occur with these patients, hospital intervention is often required to save the patient’s life.

Despite the severity of the risk, one-by-one the new generation anticoagulants entered the market, even with the numerous problems that appeared. Pradaxa was the first one on the block, being approved in 2010 and manufactured by Boehringer Ingelheim; it was the first drug to directly compete with Warfarin. It proved to be a market success, but the bleeding complications soon became apparent that led to numerous lawsuits against Boehringer.

A year later, Xarelto was approved and was released as a joint venture by Janssen Pharmaceuticals and Bayer Pharmaceuticals. The companies’ aggressive marketing paid off, surpassing Pradaxa in popularity; however, the same bleeding problems also brought the drug down from its popularity. Janssen and Bayer are now facing thousands of Xarelto bleeding injuries, similar to what Boehinger had faced with Pradaxa.

As for Eliquis, it was approved in 2012 and is manufactured by Pfizer and Bristol-Meyers Squibb. Like its older cousins, Eliquis is being groomed to be a market success, but most likely has the same bleeding side effects as Pradaxa and Xarelto. It remains to be seen if Pfizer and Bristol will face the same fate as Boehringer, Bayer, and Janssen, but experts are less than optimistic on the outcome.