From the Guidelines
It is strongly advised to avoid using anti-inflammatory medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), with Eliquis (apixaban) due to the increased risk of bleeding. Both Eliquis and NSAIDs can elevate bleeding risk, and their combined use may significantly increase this danger 1. For pain relief while on Eliquis, acetaminophen (Tylenol) is typically considered safer as it doesn't affect blood clotting. If an anti-inflammatory medication is absolutely necessary while on Eliquis, it's crucial to consult a healthcare provider first, as they may recommend the lowest effective dose for the shortest possible time or suggest alternative pain management strategies. This caution is based on the understanding that Eliquis is an anticoagulant preventing blood clot formation by inhibiting Factor Xa in the clotting cascade, while NSAIDs reduce blood clotting ability by inhibiting platelets and prostaglandin production.
The most recent and highest quality study on drug interactions affecting oral anticoagulant use, including Eliquis, emphasizes the importance of minimizing the risk of bleeding when combining anticoagulants with other medications that may increase this risk, such as antiplatelet therapy or NSAIDs 1. This study highlights the need for careful consideration and monitoring when patients are on multiple medications that can affect bleeding risk, underscoring the importance of medical supervision in these cases.
Key considerations for managing patients on Eliquis who require pain management include:
- Avoiding NSAIDs due to the increased risk of bleeding
- Using acetaminophen as a safer alternative for pain relief
- Consulting a healthcare provider before initiating any anti-inflammatory medication
- Carefully monitoring for signs of bleeding when combining medications that may increase bleeding risk
- Following the most recent guidelines and recommendations for minimizing bleeding risk in patients on anticoagulant therapy 1.
From the FDA Drug Label
Naproxen may decrease platelet aggregation and prolong bleeding time. The FDA drug label does not answer the question about the safety of using antiinflammatories with Eliquis.
From the Research
Anti-Inflammatory Medications and Eliquis
- The safety of using anti-inflammatory medications with Eliquis (apixaban) is a concern due to the potential increased risk of bleeding 2.
- A study published in Circulation found that incident nonsteroidal anti-inflammatory drug (NSAID) use was associated with an increased risk of major bleeding and clinically relevant nonmajor bleeding in patients taking apixaban or warfarin 2.
- However, another study published in the Journal of Pain Research suggests that coprescribing proton-pump inhibitors (PPIs) with NSAIDs may potentiate gastrointestinal risks associated with NSAIDs 3.
- Topical NSAIDs may be considered as comparable alternatives to oral NSAIDs, with fewer serious adverse events, such as gastrointestinal reactions 4.
- Indomethacin, a nonsteroidal anti-inflammatory drug, has been effectively used in the management of mild-to-moderate pain, but its use with Eliquis has not been specifically studied 5.
Key Findings
- NSAID use with apixaban or warfarin may increase the risk of bleeding 2.
- PPIs may potentiate gastrointestinal risks associated with NSAIDs 3.
- Topical NSAIDs may be a safer alternative to oral NSAIDs 4.
- Indomethacin has been used to manage mild-to-moderate pain, but its use with Eliquis is not well-studied 5.
Considerations
- Patients taking Eliquis should be cautious when using anti-inflammatory medications, especially NSAIDs, due to the potential increased risk of bleeding 2.
- The use of PPIs with NSAIDs should be carefully considered, as it may potentiate gastrointestinal risks 3.
- Topical NSAIDs may be a viable alternative for patients who require anti-inflammatory medication and are taking Eliquis 4.