QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF For Our Patients Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Knijff-Dutmer, E. A. Articles by van de Laar, M. A. Search for Related Content PubMed PubMed Citation Articles by Knijff-Dutmer, E. A. Articles by van de Laar, M. A.

DRUG INTERACTIONS

Concomitant Coumarin–NSAID Therapy and Risk for Bleeding

Rheumatologist, Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands

Gelte A Schut, PharmD

Pharmacist, Stroinkslanden Pharmacy, Enschede

Martin AFJ van de Laar, MD

Rheumatologist, Department of Rheumatology, Medisch Spectrum Twente

Reprints: Ellen AJ Knijff-Dutmer MD, Department of Rheumatology, Medisch Spectrum Twente, PO Box 50,000, 7500 KA Enschede, the Netherlands, FAX 31 53 487 3106, E-mail eajknijff{at}hotmail.com

OBJECTIVE: To investigate the risk of bleeding complications during the combined use of coumarin derivatives and nonsteroidal antiinflammatory drugs (NSAIDs) compared with the use of coumarin derivatives alone.

SUBJECTS AND METHODS: In this 1-year observational study, the local outpatient anticoagulation office detected all coumarin users with bleeding complications. These patients were sent questionnaires regarding the type and consequences of the bleeding as well as previous NSAID use. The local pharmacists detected patients with concomitant coumarin and NSAID prescriptions (but no bleeding). The relative risk for bleeding due to concomitant coumarin and NSAID use was estimated.

RESULTS: During 1 year, 738 hemorrhages were identified in 681 coumarin users. In 12.2% of these cases, an NSAID was involved. In contrast, in the whole population of coumarin users, 2.5% were prescribed an NSAID. Therefore, the relative risk of NSAID use with regard to bleeding complications was 5.8 (95% CI 2.3 to 13.6).

CONCLUSIONS: NSAID use during coumarin therapy considerably increases the bleeding risk compared with coumarin therapy alone. Although in daily practice these medications are frequently prescribed concomitantly, our results underscore the contraindication of concomitant use of NSAIDs and coumarin derivatives.

Key Words: bleeding, coumarin derivatives, nonsteroidal antiinflammatory drugs

www.theannals.com, DOI

This article has been cited by other articles:

				D. C. Malone, D. S. Hutchins, H. Haupert, P. Hansten, B. Duncan, R. C. Van Bergen, S. L. Solomon, and R. B. Lipton Assessment of potential drug-drug interactions with a prescription claims database Am. J. Health Syst. Pharm., October 1, 2005; 62(19): 1983 - 1991. [Abstract] [Full Text] [PDF]

				M. N. Levine, G. Raskob, R. J. Beyth, C. Kearon, and S. Schulman Hemorrhagic Complications of Anticoagulant Treatment: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 287S - 310S. [Abstract] [Full Text] [PDF]

				C. Stollberger and J. Finsterer Both Thrombotic and Nonthrombotic Cardiovascular and Cerebrovascular Side Effects of Nonsteroidal Anti-Inflammatory Drugs Should Be Considered Stroke, February 1, 2004; 35 (2): e26 - e26. [Full Text] [PDF]

				E.A.J. Knijff-Dutmer, J. Van der Palen, G. Schut, and M.A.F.J. Van de Laar The influence of cyclo-oxygenase specificity of non-steroidal anti-inflammatory drugs on bleeding complications in concomitant coumarine users QJM, July 1, 2003; 96(7): 513 - 520. [Abstract] [Full Text] [PDF]