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Certain Painkillers Might Raise Bleeding Risks For People On Blood Thinners
People on blood thinners have a doubled risk of dangerous internal bleeding if they also take a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen, a new study warns. Photo by Adobe Stock/HealthDay News
People on blood thinners have a doubled risk of dangerous internal bleeding if they also take a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen, a new study warns.
People typically are prescribed blood thinners to treat or prevent strokes, heart attacks, or blood clots in the legs or lungs, researchers said.
NSAIDs also are known to thin the blood, and the new study shows that they can increase risk of uncontrolled bleeding in the gut, brain, lungs and bladder if taken alongside a blood thinner.
"We found that for patients taking blood thinners for blood clots in the legs or lungs, using NSAIDs doubled the risk of bleeding compared with not using NSAIDs," said researcher Soren Riis Peterson, a medical student with Aarhus University Hospital in Denmark. "The increased bleeding risk associated with NSAID use was not limited to the digestive tract but also seemed to affect other organ systems."
For the study, researchers analyzed data on nearly 52,000 Danish patients prescribed a blood thinner to treat a blood clot between 2012 and 2022.
In Denmark, the NSAIDs diclofenac and naproxen can only be obtained through a prescription. This allowed researchers to track the health of patients who had been prescribed both a blood thinner and an NSAID.
Overall, the risk of a bleed was two times higher when people took a blood thinner and an NSAID, compared to just taking a blood thinner, researchers found.
The specific risk was four times higher for naproxen, three times higher for diclofenac and nearly twice as high for ibuprofen.
Specific bleed risks included:
2.2 times higher risk of a gut bleed
3.2 times higher risk of a brain bleed
1.4 times higher risk of a lung bleed
1.6 times higher risk of a urinary tract bleed
Using NSAIDs with a blood thinner also tripled a person's risk of anemia, researchers found.
The pattern of risk remained similar across a wide variety of blood thinners, including rivaroxaban, apixaban, dabigatran, edoxaban and warfarin, results show.
The new study was published Sunday in the European Heart Journal.
"For people taking blood thinners for blood clots in their legs or lungs, our research highlights the importance of being cautious when considering NSAIDs for pain or inflammation," Petersen concluded in a journal news release. "We recommend that patients consult their doctor before taking NSAIDs along with a blood thinner."
In an accompanying editorial, Dr. Robert Storey, a professor of clinical cardiology with the University of Sheffield in Britain, noted that NSAIDs are widely used, making up about 8% of prescriptions worldwide and often available over-the-counter.
"It seems clear that avoiding NSAIDs in combination with [blood thinners] is the safest strategy to avoid excess bleeding risk," Storey wrote. "However, if this is not possible, what mitigation can be put in place? NSAID prescription should obviously be at the lowest dose and for the shortest time possible, but choice of agent and route may also be important."
More information
The Cleveland Clinic has more on blood thinners.
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Newer Blood Thinner Cuts Odds For Stroke After Heart Valve Surgery
TUESDAY, Nov. 19, 2024 (HealthDay News) -- Japanese researchers say they have found a pill that works as well as existing medication to prevent blood clots after heart valve surgery, with fewer trips to the doctor.
Unlike warfarin, the standard treatment, edoxaban does not require regular monitoring of blood clotting activity and doesn't interact with other meds.
"Edoxaban could make life easier for patients recovering from heart valve surgery," said study leader Dr. Chisato Izumi, of the National Cerebral and Cardiovascular Center in Suita, Japan.
"Since this medication does not require regular blood tests to monitor anticoagulation activity and can be taken in a fixed dose, without fears of interaction with food or other medications, it reduces the burden on patients and improves their quality of life, especially in those crucial first few months after surgery," she added.
Izumi presented her team's findings Monday at a meeting of the American Heart Association in Chicago. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
The U.S. Food and Drug Administration approved edoxaban in 2015 for patients with a form of atrial fibrillation (A-fib) caused by rapid and irregular beating of the heart's top chambers, not a heart valve problem.
For this trial, researchers compared its use to warfarin in about 400 patients in Japan who had heart valve replacement surgery. Participants received either edoxaban or warfarin for 12 weeks.
Compared to warfarin, edoxaban was as effective -- or even more so -- in preventing stroke and blood clots, researchers said.
In all, 0.5% of edoxaban patients had a stroke or embolism compared to 1.5% of those who took warfarin.
However, 4.1% in the edoxaban group had major bleeding, compared to 1% of the warfarin group. One patient taking warfarin had a fatal brain hemorrhage, but there were no brain hemorrhages or fatal bleeding in edoxaban patients.
None of the edoxaban patients suffered a blood clot in the heart, but 1% of warfarin patients did.
Finally, those taking edoxaban did have higher rates of gastrointestinal bleeding than those taking warfarin (2.1% versus 0%).
"Our findings show that edoxaban could help prevent blood clots as effectively as warfarin, indicating it is a viable post-surgery treatment alternative to consider for patients who have received a bioprosthetic heart valve replacement," Izumi said in a meeting news release.
Researchers said additional study is needed to learn which patients are more likely to bleed if they take edoxaban, and how to reduce that risk.
They noted that both patients and doctors knew which medication participants were receiving, which could have biased the results. The study did not include patients whose valves were replaced with man-made devices.
More information
MedlinePlus has more about blood thinners and how they work.
SOURCE: American Heart Association, news release, Nov. 17, 2024
Patients recovering from heart valve surgery may be able to take a blood thinner that doesn't require frequent trips to the doctor for monitoring.
Blood In Urine Or Stool Could Indicate Vitamin K Deficiency: Other Common Symptoms To Watch Out For
Your body often sends signals to indicate any underlying health issues, and recognising these signs early is crucial. For instance, blood in urine and stool may point to a vitamin K deficiency.
While bloody urine or stool can occur due to various causes, addressing it promptly is important, especially if it's linked to a lack of vitamin K. Speaking with the OnlyMyHealth team, Dr Ajay Shah, Managing Director of Neuberg Ajay Shah Laboratory, delves into the connection between these two conditions and highlights other common symptoms that can help identify this link.
Also Read: Do You Frequently Bump Into Things And Bruise? Here's What You Should Add In Your Diet
What Causes Vitamin K Deficiency?Vitamin K deficiency occurs primarily due to a lack of vitamin K-rich foods in your diet. It is mostly found in leafy green vegetables like spinach, kale, and chard. Vitamin K is a fat-soluble vitamin that helps the liver produce clotting factors that cause blood to clot and maintain strong bones and reduce the risk of osteoporosis, especially in older adults.
While it is rare in healthy adults, it can occur in anyone, including infants, during the first few weeks due to low levels in breast milk.
Other factors that lead to vitamin K deficiency include health problems like coeliac disease, Crohn's disease, cystic fibrosis, or gallbladder disease that can prevent the body from absorbing vitamin K. Moreover, certain medications, like antibiotics and blood thinners, can also lead to vitamin K deficiency.
Common Symptoms Of Vitamin K DeficiencyAccording to MSD Manuals, the main symptom of vitamin K deficiency is bleeding (haemorrhage) into the skin, which causes bruises, from the nose, from a wound, in the stomach, or in the intestine. Sometimes bleeding in the stomach can also cause vomiting with blood. Other common symptoms include:
In newborns, bleeding within or around the brain may also occur due to severe vitamin K deficiency. Additionally, if you have a liver disorder, it may increase the risk of bleeding because clotting factors are made in the liver, according to the MSD Manual.
If symptoms do not give you clarity, blood tests that measure prothrombin time (PT) can help diagnose vitamin K deficiency. This particular test helps indicate how long it takes for blood to clot. Prolonged PT suggests impaired clotting, potentially due to low vitamin K levels. Additional tests, like a vitamin K assay, may also help confirm the condition.
Also Read: Vitamin K-Rich Foods To Strengthen Bones And Keep Your Heart Healthy
Why Vitamin K Deficiency Causes Blood In Stool Or UrineAs discussed, vitamin K deficiency can cause blood in stool or urine because it helps our body produce proteins necessary for blood clotting. These clotting factors, including prothrombin (factor II) and factors VII, IX, and X, are important for normal blood clotting. Without adequate vitamin K, the production of these proteins is impaired, leading to a reduced ability for blood to clot properly. This can result in excessive or spontaneous bleeding, even in minor injuries or internally, such as in the gastrointestinal or urinary tracts.
When your body cannot clot blood efficiently, internal bleeding may occur in the stomach, intestines, or urinary system. Gastrointestinal bleeding can cause blood in the stool, which may appear bright red or black and tarry depending on the location and severity of the bleed. Similarly, bleeding in the urinary tract can lead to haematuria, or blood in urine, often appearing as pink, red, or brown discolouration. It is crucial to get immediate medical attention if these symptoms appear, as they can indicate severe vitamin K deficiency or other underlying health conditions.
How To Manage Vitamin K Deficiency SymptomsTo manage or even prevent vitamin K deficiency-associated symptoms, consider the following:
Dr Shah advises consulting a doctor if you experience persistent or unexplained bleeding or bruising even after following proper dietary changes or hydration. Symptoms of bone fragility or fractures and conditions that affect nutrient absorption, such as coeliac disease or Crohn's disease, can all be signs of underlying issues related to vitamin K deficiency, he says, adding that if you are taking medications like blood thinners, it's important to be aware that these drugs can interact with vitamin K levels, potentially exacerbating the deficiency. Monitoring these symptoms and discussing them with a healthcare provider is crucial for early intervention and management, he concludes.
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