Taking nonsteroidal anti-inflammatory drugs (NSAIDs) while on anticoagulants (blood thinners) can significantly increase a person’s risk for internal bleeding, according to a new study.

Researchers analyzed data from more than 51,000 individuals with venous thromboembolism (VTE), a condition that causes blood clots in the veins. These individuals were treated with blood thinners. The study found that taking NSAIDs along with various types of blood thinners doubled the risk of internal bleeding. The risk was highest with naproxen (4.1 times higher), followed by diclofenac (3.3 times higher), then ibuprofen (1.79 times higher). The study found significant bleeding risks in critical areas, such as the gastrointestinal tract (which can cause ulcers or stomach bleeding) and the brain (potentially leading to life-threatening hemorrhages). Although the study focused on individuals with VTE, the findings are relevant for anyone taking blood thinners, as NSAIDs and anticoagulants interact similarly across conditions.

Notably, the risk of serious bleeding from taking NSAIDs and blood thinners is still relatively low. According to the study, for every 100 people on blood thinners who take NSAIDs, around 6 will experience bleeding within a year. This is nearly double the risk compared to people who avoid NSAIDs, where between 3 and 4 people out of 100 will experience bleeding in the same time frame.

Why NSAIDs Pose a Danger

Doctors frequently prescribe blood thinners, such as warfarin (Coumadin), apixaban (Eliquis), and rivaroxaban (Xarelto), for heart disease to reduce the risk of blood clots. Clots can block blood flow to critical areas in the body, causing life-threatening conditions like heart attacks, strokes, or pulmonary embolisms (clots in an artery of the lungs). NSAIDs, commonly used to manage pain and inflammation, can aggravate the risk of bleeding by disrupting blood clotting and damaging the stomach lining. These effects are compounded when NSAIDs are combined with blood thinners, increasing the likelihood of severe internal bleeding​​.

If you’re living with heart disease and taking blood thinners, speak with your doctor about alternatives to NSAIDs for managing pain. These may include acetaminophen or nondrug options, such as physical therapy, acupuncture, or lifestyle changes.

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