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Abstract Nonsteroidal anti-inflammatory drugs NSAIDs are known to interact with the oral anticoagulant warfarin and can cause a serious bleeding complication. Study design This study was a retrospective case control study using medical records in a tertiary hospital. Statistical analysis To explore the risk factors associated with INR increase, age, sex, BMI, underlying diseases, species of NSAIDs, indications for warfarin, maintenance dose of warfarin, baseline PT INR , baseline liver function test results, baseline renal function test results, and the presence of coadministered medications were regarded as independent variables.
Table 1 Characteristics of the study population. Open in a separate window. NSAIDs, nonsteroidal anti-inflammatory drugs. References 1. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Anticoagulation in hospitals and general practice. Risk of primary intracerebral haemorhage associated with aspirin and nonsteroidal anti-inflammatory drugs: case-control study.
Potential interaction between acenocoumarol and diclofenac naproxen and ibuprofen and role of CYP2C9 genotype. Thromb Haemost. Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs. Clin Pharmacokinet. Harder S, Thurmann P. Clinically important drug interactions with anticoagulants. An update. Ann Pharmacother. Chan TY. Prolongation of prothrombin time with the use of indomethacin and warfarin.
Br J Clin Pract. Potential interaction between celecoxib and warfarin. Warfarin and celecoxib interaction. Seven cases of interaction between warfarin and cyclooxygenase-2 inhibitors.
Am J Health Syst Pharm. Interaction of rofecoxib and celecoxib with warfarin. Interactions of warfarin with drugs and food. Ann Intern Med. Bleeding complications in oral anticoagulant therapy. An analysis of risk factors. Arch Intern Med. No bleeding events were reported during the study. The mean maximum increase in INR was 0. Notably, treatment was discontinued when the INR rose to 3. A meta-analysis included 7 randomized controlled trials with patients taking vitamin K antagonists, including warfarin and phenprocoumon, who received 1.
The mean INR increase for patients taking acetaminophen and warfarin concomitantly was 0. The trials excluded patients with labile INRs and the INR was carefully monitored throughout the trials, possibly contributing to the small number of bleeding events. Several mechanisms have been proposed to explain the interaction between acetaminophen and warfarin. Other mechanisms may include the production of peroxynitrite and subsequent inactivation of VKOR, as well as competitive inhibition of warfarin metabolism by acetaminophen through the CYP enzymes.
Despite the availability of evidence of the interaction between acetaminophen and warfarin since the s, data concerning the clinical significance of the interaction remains scarce.
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