Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy: a nationwide cohort study
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Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy : a nationwide cohort study. / Lamberts, Morten; Lip, Gregory Y H; Hansen, Morten Lock; Lindhardsen, Jesper; Olesen, Jonas Bjerring; Raunsø, Jakob; Olsen, Anne-Marie Schjerning; Andersen, Per Kragh; Gerds, Thomas Alexander; Fosbøl, Emil Loldrup; Torp-Pedersen, Christian; Gislason, Gunnar H.
I: Annals of Internal Medicine, Bind 161, Nr. 10, 18.11.2014, s. 690-8.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy
T2 - a nationwide cohort study
AU - Lamberts, Morten
AU - Lip, Gregory Y H
AU - Hansen, Morten Lock
AU - Lindhardsen, Jesper
AU - Olesen, Jonas Bjerring
AU - Raunsø, Jakob
AU - Olsen, Anne-Marie Schjerning
AU - Andersen, Per Kragh
AU - Gerds, Thomas Alexander
AU - Fosbøl, Emil Loldrup
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar H
PY - 2014/11/18
Y1 - 2014/11/18
N2 - BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown.OBJECTIVE: To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy.DESIGN: Observational cohort study.SETTING: Nationwide registries.PATIENTS: Danish patients with AF hospitalized between 1997 and 2011.MEASUREMENTS: Absolute risk for serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy, assessed by using Cox models.RESULTS: Of 150 900 patients with AF (median age, 75 years [interquartile range, 65 to 83 years]; 47% female), 53 732 (35.6%) were prescribed an NSAID during a median follow-up of 6.2 years (interquartile range, 2.1 to 14.0 years). There were 17 187 (11.4%) and 19 561 (13.0%) occurrences of serious bleeding and thromboembolism, respectively. At 3 months, the absolute risk for serious bleeding within 14 days of NSAID exposure was 3.5 events per 1000 patients compared with 1.5 events per 1000 patients without NSAID exposure. The risk difference was 1.9 events per 1000 patients. In patients selected for oral anticoagulant therapy, the absolute risk difference was 2.5 events per 1000 patients. Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding.LIMITATION: Observational design and unmeasured confounders.CONCLUSION: Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with AF. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with AF.PRIMARY FUNDING SOURCE: None.
AB - BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown.OBJECTIVE: To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy.DESIGN: Observational cohort study.SETTING: Nationwide registries.PATIENTS: Danish patients with AF hospitalized between 1997 and 2011.MEASUREMENTS: Absolute risk for serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy, assessed by using Cox models.RESULTS: Of 150 900 patients with AF (median age, 75 years [interquartile range, 65 to 83 years]; 47% female), 53 732 (35.6%) were prescribed an NSAID during a median follow-up of 6.2 years (interquartile range, 2.1 to 14.0 years). There were 17 187 (11.4%) and 19 561 (13.0%) occurrences of serious bleeding and thromboembolism, respectively. At 3 months, the absolute risk for serious bleeding within 14 days of NSAID exposure was 3.5 events per 1000 patients compared with 1.5 events per 1000 patients without NSAID exposure. The risk difference was 1.9 events per 1000 patients. In patients selected for oral anticoagulant therapy, the absolute risk difference was 2.5 events per 1000 patients. Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding.LIMITATION: Observational design and unmeasured confounders.CONCLUSION: Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with AF. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with AF.PRIMARY FUNDING SOURCE: None.
U2 - 10.7326/M13-1581
DO - 10.7326/M13-1581
M3 - Journal article
C2 - 25402512
VL - 161
SP - 690
EP - 698
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 10
ER -
ID: 134780787