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Long-Term NSAID Use Ups Risk of Atrial Fibrillation

Other study finds adding clopidogrel to warfarin triples risk of bleeding in a-fib

TUESDAY, Sept. 14 (HealthDay News) -- Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of chronic atrial fibrillation (AF), according to research published in the Sept. 13 issue of the Archives of Internal Medicine. According to a second study published in the same issue, using combinations of anticoagulants -- as opposed to warfarin alone -- significantly raises the risk of bleeding events in patients with AF.

Raffaele De Caterina, M.D., of "G. d'Annunzio" University in Chieti, Italy, and colleagues conducted nested case-control studies which confirmed that the long-term use of corticosteroids is associated with an increased risk of chronic AF (rate ratio, 2.49), and discovered that long term use of NSAIDs also increased the risk (rate ratio, 1.44). The researchers could not prove a direct cause-effect relationship between NSAIDs and AF; since the use of anti-inflammatory drugs in general usually reflects underlying inflammatory disorders, inflammation itself may explain the link between the two.

Morten L. Hansen, M.D., of the Copenhagen University Hospital Gentofte in Denmark, and colleagues conducted a cohort study using nationwide registries to determine the risk of nonfatal and fatal bleeding when AF is treated with combinations of warfarin, aspirin, and clopidogrel as opposed to warfarin alone. The researchers found that dual treatment with warfarin and clopidogrel, as well as triple therapy with all three drugs, increased the risk of a bleeding event by more than three-fold.

"Combinations of warfarin, aspirin, and clopidogrel are frequently used in patients with AF. In real-life circumstances, combination therapy is associated with a much higher risk of severe bleeding than previously recognized," Hansen and colleagues conclude.

The original data collection for the ascertainment of cases of AF for the De Caterina study was performed with an unrestricted research grant from AstraZeneca. The Hansen study was supported by a grant from the Sanofi-Aventis group.

Abstract - De Caterina
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Abstract - Hansen
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