Coumadin & NSAIDs

[Dodgy Ticker]

Hi all

I wanted to write this post as it has been swirling around in my head for a few weeks, but is REALLY important. Firstly, however:

1. I am NOT a doctor, so please - before doing anything out of the ordinary - check with your doctor or cardio first. And
2. This is not a recommendation. I am just retelling my recent story.

As a sufferer of numerous spinal and back problems for over 30 years, these were at the back of my mind when I was attacked by Infective Endocarditis 2.5 years ago, and rushed to A&E where they saw the astonishingly destroyed state of my heart.With little time to make a decision, I decided to go with mechanic valves, as the thought of OHS again in 10 years was too much to stomach. I was made aware of the pros and cons of mechanical vs natural valves, and decided that a life of peace was preferable.

A short time later, however, I was having a bad bout of back problems, and realised that my usual NSAIDs that had managed to keep me going for many years, would no longer be an option. Indeed, apart from damned Paracetamol (with added codeine), there were no reasonable options.

To make a long story nauseous, by back problems have taken a serious turn for the worse, ending in me tumbling on nothing and fracturing my femur 2 months ago following two extreme attacks of sciatica. The pain was just unbelievable.

Rushed to the A&E, I said to the doctor - "I don't give a damned about my Warfarin - just give me some NSAIDs to calm the **** down!"

I was told "Yes - no problem - we'll just have to change the dosage and the way we manage your anti-coagulation"

I WAS FLOORED!!

Up til then, it was a clear and unequivocal 'no, you can't use NSAIDs when on Warfarin"

So we stopped the Warfarin straight away and I was administered some anti-inflammatories. RELIEF AT LAST !!!

We pretty quickly (post surgery) started to measure my INR on a daily basis and administered the Warfarin with appropriate doses, until about 2 weeks later - it had stabilised to where it needed to be.

So the moral of the story is that it absolutely IS possible to use NSAIDs if really necessary. You just need to do it under medical supervision and a very close regime of blood monitoring.

Hope this is of interest/help

 

[Critter]

Yes I currently use celecoxib for back musculoskeletal pain that I only take occasionally. My cardiologist was ok with it. I check my INR at home so it really is not a problem.

 

[almost_hectic]

I take ibuprofen from time to time, even my surgeon said once in a while is fine. Too much will make managing INR more difficult. Plus there’s a concern for some patients that too much nsaids can cause stomach ulcers and bleeding that would be very much of a problem.

 

[RAS]

So the moral of the story is that it absolutely IS possible to use NSAIDs if really necessary. You just need to do it under medical supervision and a very close regime of blood monitoring.

Agree.
I take non prescription strength Naproxen 1-2 times per week. My Cardio has never objected. I have at times taken prescription strength NSAIDs such as Diclofenac (By far the most effective NSAID I have ever taken) as well for short periods.

So many medicines and foods interact with Warfarin to impact INR one way or the other that absolute prohibition of entire classes of meds or foods is just not practical. This is why we test!. This why many of us test at home to have maximum flexibility and control of managing our INR and dosing.

 

[Astro]

Extended use of NSAIDS (anti-inflammatories such as ibuprofen, diclofenac) can weaken the stomach’s acid barrier lining. This can lead to ulcers.
Stomach/duodenal ulcers (which often bleed) + warfarin = trouble
Occasional NSAIDs use is unlikely to be a problem. I do use ibuprofen occasionally and have not noticed a change in INR.
COX2 inhibitors (for example celecoxib) are a group of anti-inflammatories that produce less stomach lining effects than NSAIDS so make sense if you need anti-inflammatories more often. Anti-acid medication (for example pantoprazole, omeprazole) can also help to reduce the risk of ulcers.

 

[pellicle]

I wanted to write this post as it has been swirling around in my head for a few weeks, but is REALLY important.

I'm not sure if you saw this post of mine:
https://www.valvereplacement.org/threads/ibuprofen.887853/

 

[slipkid]

I wonder (because no Dr has ever explained this to me) - I am on Prevacid (a proton pump inhibitor) which keeps my godawful acid reflux disease in check (structurally I have something wrong there with my watchamacallit valve/sphincter thx to a hiatal hernia). Does the prevacid/PPI contribute in any way to the risk of something like NSAIDS either affecting warfarin or increasing stomach lining problems? Because I am not allowed to take ibuprofen but was given no reason other than "you can't take that since you are on warfarin".

 

[RAS]

Something I ran across awhile ago - PPI may actually help counter the NSAID risk. Take a look at the charts in this article. Safety and Efficacy Considerations for Chronic Use of NSAIDs for Chronic Pain

Here is a relevant quote.
" Nevertheless, the risk of experiencing gastrointestinal adverse effects largely depends on the patient’s risk factors (Table 3).4 Accordingly, in patients with existing gastrointestinal risk factors who require an NSAID, celecoxib appears to be safer compared to other agents of its class and may be used with close monitoring.4 The addition of a proton pump inhibitor (PPI) may further decrease the risk of NSAID-related gastrointestinal adverse effects and should be considered for the duration of NSAID treatment "

 

[slipkid]

Something I ran across awhile ago - PPI may actually help counter the NSAID risk. Take a look at the charts in this article. Safety and Efficacy Considerations for Chronic Use of NSAIDs for Chronic Pain

Here is a relevant quote.
" Nevertheless, the risk of experiencing gastrointestinal adverse effects largely depends on the patient’s risk factors (Table 3).4 Accordingly, in patients with existing gastrointestinal risk factors who require an NSAID, celecoxib appears to be safer compared to other agents of its class and may be used with close monitoring.4 The addition of a proton pump inhibitor (PPI) may further decrease the risk of NSAID-related gastrointestinal adverse effects and should be considered for the duration of NSAID treatment "

Thanks. I was suspicious that since the PPI REDUCES my stomach acid to a very large degree that perhaps I COULD take NSAIDs, but of course not one single Dr I have seen has acknowledged this or even thought to discuss it, not even when I have had badly pulled back muscles and asked to please can I take Ibuprofen for a couple days - always told NO - you are on warfarin, you must NEVER EVER take Ibuprofen for any reason not even once etc etc etc.

 

[tom in MO]

Most doctors will not prescribe NSAIDs if you are on warfarin. The best doctors will tell you your condition could use NSAIDs, but to ask your cardio if you can take them. Mine allows OTC NSAIDs for not more than 3 months at the lowest effective dose not to exceed 3 months total time.

 

[Dodgy Ticker]

Thanks for your comments folks. All power and health to you all.