Bad mix: Blood thinners and NSAIDs

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Take the lowest dose of NSAIDs and stop using them as soon as possible.

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Blood thinners are usually given to people at risk for developing blood clots from conditions, such as abnormal heart rhythms. Use of these lifesaving medications requires caution with other drugs, especially painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve). But plenty of people take the risk to relieve aches and pains. “Many of the patients who need blood thinners are older and therefore at risk for arthritis, so it’s not infrequent for a patient to be on both a blood thinner and an NSAID,” says cardiologist Dr. Deepak L. Bhatt, a Harvard Medical School professor.

About blood thinners

Blood thinners come in two classes: Antiplatelet drugs such as aspirin stop platelets from forming clots. Anticoagulants such as warfarin (Coumadin) and the newer direct acting oral anticoagulants (DOACs) lengthen the time it takes to form a blood clot. NSAIDs affect the way platelets work and could interfere with normal blood clotting. “That could raise the risk of bleeding, especially in the digestive tract. Taking them together with blood thinners raises the bleeding risk even more,” says Dr. Bhatt.

What you can do

If you’re taking a blood thinner, your options for pain relief are limited. Sometimes physical therapy can help relieve joint pain by strengthening the muscles that support the joints to better absorb stress. But there are times when painkillers are needed, such as when arthritic pain won’t go away. Acetaminophen (Tylenol) can usually be used, but high doses come with the possible risk of liver damage. “When painkillers are needed, it’s best to use the lowest dose that reduces symptoms and to stop taking them if the symptoms subside,” advises Dr. Bhatt. And make sure you talk to your doctor before mixing any type of painkiller with a blood thinner.

Find the hidden NSAIDs

Sometimes NSAIDs and aspirin are obvious ingredients in over-the-counter remedies, but not always. Talk to your doctor before taking any of these drugs in addition to your blood thinner.

Product name

Used for

Contains

Advil, Motrin, Nuprin

aches, pains, headache

ibuprofen

Aleve

aches, pains, headache

naproxen

Excedrin, Bayer, Bufferin, Asper Gum

aches, pains, headache

aspirin

Alka-Seltzer

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indigestion

aspirin

Pepto-Bismol, Maalox, Kaopectate

indigestion, diarrhea

bismuth subsalicylate (related to aspirin)

Advil PM

sleep aid, pain reliever

ibuprofen

Alka-Seltzer plus

common cold

aspirin

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