NSAIDS and Blood thinners?

Hi Docs,

I’m on blood thinners following the receipt of a stent. I have been warned to take absolutely no NSAIDS due to the risk of bleeding. Nevertheless, I find that for the occasional neck pain, Naproxen works way better than Acetaminophen. I can’t really find anything on the interwebs or Dr. Google about the actual risks of taking Naproxen every month or so and from where the bleeding would commence. I would appreciate hearing your thoughts on this. I asked my cardiologist. The answer I got was that no dose was safe for me.

Thanks

NSAIDs do increase the risk of cardiovascular events, particularly in high risk individuals (such as you, since you have received a stent) and particularly when taken at high doses. In low-risk individuals without known cardiovascular disease, they are associated with a small absolute increase in cardiovascular risk (with Naproxen having the mildest effects, and in some studies, no significant effect).

NSAIDs also interfere with platelet function that can predispose to bleeding, particularly from the GI tract. This risk is higher in individuals with a recent stent, since they’re typically also prescribed dual-antiplatelet therapy (e.g., aspirin and clopidogrel or ticagrelor) that themselves increase bleeding risk too.

In general, most physicians are going to be reluctant to recommend the use of NSAIDs to someone who has known cardiovascular disease and a recent stent in place.