Nonsteroidal anti-inflammatory drugs (NSAIDS) should be avoided by a patient taking oral anticoagulants for atrial fibrillation according to the RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) Study.

Adverse effects seen with taking NSAIDS together with warfarin or dabigatran:

(1) increased risk for major bleeding, including gastrointestinal bleeding

(2) increased risk for stroke or systemic embolism

(3) increased risk for hospitalization


The risk of myocardial infarction was not increased by NSAID use (page 258).


Older patients with osteoarthritis or other chronic pain condition are a problematic group.

(1) Acetaminophen (Tylenol) may not provide effective pain control if inflammation is present.

(2) Opiates have an addiction potential and other side-effects.

(3) Cyclo-oxygenase-2 inhibitors (COX-2 inhibitors) may convey cardiovascular risk.

To read more or access our algorithms and calculators, please log in or register.