Increased Risk of Blood Clots with NSAIDs Use

By Patricia Iyer MSN RN LNCC

(Pat is a legal nurse consultant who provides education to healthcare providers about patient safety. She can be reached at patriciaiyer@gmail.com)

New evidence shows the patient receiving nonsteroidal anti-inflammatory drugs (NSAIDs) is at increased risk for developing a venous thromboembolism. NSAIDs are commonly prescribed for people with pain.

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Commonly used NSAIDs:

  • Aspirin
  • Celebrex
  • Volatren
  • Motrin
  • Advil
  • Feldene
  • Daypro
  • Indocin
  • Aleve
  • Anaprox
  • Naprosyn

Manufacturers have stopped selling these NSAIDs: Lodine, Dolboid, Disalsate, Clinoril and Tolectin

NSAIDs have common side effects:

  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Rash
  • Dizziness
  • Headache
  • Decreased appetite
  • Drowsiness

Serious complications of NSAIDs

These side effects sound pretty benign, but there are also serious complications associated with NSAIDs. Patients may develop stomach bleeding, allergic reactions, kidney problems and heart problems. Now a new hazard has been identified.

Researchers in New York studied 6 studies with a total of 21,401 venous thromboembolism events. The researchers found a statistically significant increased risk of blood clots among patients who took NSAIDs. A venous thromboembolism is a blood clot which causes pain, swelling and discoloration of the affected limb. Although it can form in an arm, it is more typically seen in a leg, and is called a deep vein thrombosis. When the thrombosis breaks away from the wall of the blood vessel and travels into the circulation of the lung, a life threatening condition develops. The blood clot can cut off circulation in that part of the lung.

Pulmonary embolism symptoms

People with a pulmonary embolus are usually short of breath, breathe rapidly, have chest pain, cough, may spit up blood, have a rapid heart rate, may be dizzy, anxious and have crackles in their lungs. A large clot that blocks pulmonary circulation may kill a patient.

Up to 20% of patients who develop a pulmonary embolism die before diagnosis, and up to 11% die in the first three months even with adequate treatment.

Treatment

The medications which treat venous thromboembolism carry their own risks. Patients who develop pulmonary and deep vein thrombosis require treatment for 3 months. Low molecular weight heparin and oral anticoagulants increase the risk of bleeding. Patient safety is compromised on this medications. A patient may suffer some type of trauma, often a fall with a head injury. This can result in devastating intracranial bleeding.

This is the worst cascade of complications: pain, which leads to NSAIDs use, which leads to a deep vein thrombosis, which leads to a pulmonary embolism, which leads to needing heparin, which leads to increased risk of bleeding. Add in a fall with head trauma and the consequences can be fatal.

8 thoughts on “Increased Risk of Blood Clots with NSAIDs Use”

  1. I would caution readers to do more research as this article is misleading. The statement, “The researchers found a statistically significant increased risk of blood clots among patients who took NSAIDs.” is desperately in need of clarification as not all NSAIDs increase the risk of blood clots. Aspirin, which is correctly listed as an NSAID in the article, does the opposite by helping prevent blood clots. Aspirin is what we doctors prescribe to many of our patients for the prevention of blood clots after surgery. This article should be corrected or withdrawn in my opinion.
    Brian Fitch, MD

    Reply

    1. Thank you for your comments, Dr. Fitch. This article summarizes the meta-analysis conducted by Patompong Ungprasert, Narat Srivali, Karn Wijarnpreecha, Prangthip Charoenpong, Eric L. Knight, Non-steroidal anti-inflammatory drugs and risk of venous thromboembolism: a systematic review and meta-analysis, Rheumatology, Volume 54, Issue 4, April 2015, Pages 736–742, https://doi.org/10.1093/rheumatology/keu408. We will look into the article’s accuracy.

      Reply

      1. This is a poor review of a poor research article.
        I would not allow a person without research background to read an article and then use their credentials to rehash something they don’t understand.
        I read the entire article, I am not a physician but I am a doctorally trained RN that does research.
        The article is very clear in saying that the COX-2 (which for the general public does NOT include ASA) NSAIDs had a much different outcome than say ASA. Regretfully they do not make this clear in the abstract, which is what most people read.

        The following information is quoted from the article.

        “Conclusion. Our study demonstrated a statistically significant increased risk of VTE among NSAID users. This finding has important public health implications given the prevalence of NSAID use in the general population.” This is part of the ABSTRACT.

        “Also, aspirin, a specific and irreversible COX-1 inhibitor, has proved effective for VTE prevention [ 21 , 22 ]. This might provide further evidence that the increased VTE risk comes primarily from COX-2 inhibition.” This is part of the ARTICLE.

        Reply

  2. Is it accurate or not? I was a heavy nsaid user. Was very active and athletic. Hit my knee, got severe superficial thrombosis that nearly became dvt. 6 months of blood thinners. Multiple ultrasounds and lots of pain. Now I’m a fat piece of crap and I have severe joint pain all the time.I don’t know how I’ll ever get back to anywhere near the quality of life I used to have when it hurts just to get up and take a pee. I And now I find this out about nsaids? NSAIDs are what my dr told me to use when I first had my clots.

    Reply

    1. This post discusses the research published in Rheumatology (which is the official journal of the British Society for Rheumatology) in April of 2015. The researchers conducted a systematic review and meta-analysis of studies that reported odds ratios, relative risks, hazard ratios or standardized incidence ratios for VTE among NSAID users compared with non-users. The researchers concluded, “Our study demonstrated a statistically significant increased risk of VTE among NSAID users.” Please speak with your physician about NSAID use.

      Reply

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