Watching GPs Behind Closed Doors last night, Wednesday, I noticed that one patient on Apixaban following DVT was recommended maximum use of Ibuprofen daily, even coupled with Paracetamol. A young man.
My understanding is that these medications should not be taken together. I have avoided Ibuprofen since daily Edoxaban.
Any reflections?
I thought that ibuprofen was contraindicated for AF rather than for the NOAC's......I may be wrong though!
NSAIDs such as ibuprofen are known to be a cause of AF so must be avoided by those of us with AF. Right idea, wrong reason.
Hi all, just popping in to say happy Christmas! My af is pretty well under control I think, after a dodgy start to the year. I have to say I tweak my meds, with my gp's permission, and seem to have got it right at the moment. I get 1 or 2 mild events a month. And I have increased my exercise to 6 classes a week. Re pain killers, I take tramadol with paracetamol for arthritis, but wish I could add in ibuprofen, it works so well!! Sadly, I know I can't as I'm on rivaroxaban. Regards to everyone, Jan
When I was prescribed Apixaban, I was warned to avoid all NSAID's because of the increased risk of GI bleeding.
I haven't heard of NSAIDs being responsible for AF at all, I've been on them long term for Osteoarthritis and at no consultation for 3 ablations and 8 cardioversions have they ever been identified as a potential cause.
I have stopped taking my NSAIDs when starting Apixiban due to the risk of GI bleed even with Omeprazole as a PPI and NOT because I have AF.
Here's a link to the Danish study, jedi
Thanks! Although I don't expect EP and GP to be fully aware of all research studies all the time, I find it odd that this happened 3 years before my AF journey started, and the study is now 6 years old.... and no one has considered it! Forearmed is forewardned. Not sure where this leaves my arthritis though if proven.
As I remember it, NSAID's were implicated in the onset of AF within a year of someone starting to take them and particularly in older patients.
There was some Dutch research which agreed with the Danes at the time but nothing else that I have found.
The conclusion I read somewhere was that NSAID's should be used with care in patients over 55, because of the AF risk. How this impacts on us who already have AF wasn't made clear.
For those who must take them, physician monitoring is essential, apparently.
Ah right, maybe as I'm only 34 it doesn't apply, even if I have been on them regularly for 7 years even after 2 lots of knee surgery.
When I was first diagnosed with af in cardiac ward as I had no heart disease or other issues at the time I was asked what I used generally for pain ie headache or whatever. I said I regularly took ibuprofen and was told to stop immediately as people with af should never take anti imflamatorys.
Taking Ibuprofen in conjunction with Paracetamol is commonly recommend ed. The reason is that Ibuprofen's risk of toxicity is associated with the kidneys while Paracetamols toxicity is associated with the liver. What concerns me is the recommendation to take the "maximum dose" of Ibuprofen. I'm assuming this means the maximum daily recommended dose, or limit, as to what would be safe. The daily limit is under some degree of debate, and has varied between 1200 and 2400 mg. per day. Personally, my opinion is 1200 if taken longer-term, and 2400 is allowable if taken short-term. Taking the maximum of ibuprofen together with the maximum of paracetamol is something that if taken together, should be short-term (maybe a week, at the most)
I was told not to take ibuprofen or any anti inflammatories whilst taking apixaban. Having said that I was allowed a fortnights treatment with naproxen. If you look up the drug interactions it is not contraindicated. Not recommended for long term use though.
My own understanding is that when on an NOAC , taking Ibuprofen increases the risk of problematic bleeding further, and this should be avoided. That is why the Doctor's recommendation on the programme sparked my questioning. 0. I re read the patient info re Apixaban /Eliquis and also Edoxabsn/Lixiana and think I am correct in my thinking.
For myself I shall not be taking Ibuprofen or NSAIDs unless advised otherwise by those with more knowledge than myself.
The patient in question did not have AF, but had had a Deep Vein Thrombosis.
Perhaps the extra bleed risk , the stronger anti coagulant effect, was not an issue in his case.
Kind of a of a scary subject and food for thought. Due to injuries and infectious diseases I have been on and off high dose Ibuprofen for years. NOW I learn NSAIDS lead to a much higher chance of heart disease and such (including deep vein thrombosis). I have had CHF and AF diagnosed the last few years. So maybe not just lifestyle (good and bad). My cardiologist and my health care team have told me bluntly not to take NSAIDS. My PCP is wary of aspirin too.
When I had a head and neck injury years ago, a very good Doc steered me away from NSAIDS and used rare high dose oral "prednisone bursts" of a week or two to alleviate inflammation, with long lasting effects. But steroids have their own problems, especially with long term use. Steroids can also increase blood pressure. Now, with a broken wrist and torn ligaments and nagging old injuries, I use POLICE, alternative medicine like acupuncture, and relaxation techniques. I switch back to RICE when I over do it. Plus opiates with acetaminophen with pain holidays to decrease dependence and tolerance. A pain holiday is stopping opiate use for periods of time and thus you are in pain.
NSAIDS are not only contraindicated for long term use and meds many of us take, they also increase fluid and sodium retention, a big concern for many of us. My take away
Thanks very much for the post. It led me to in depth studying and a greater understanding.
Thank you for taking the time for this very informative response BrotherSun, and my very best wishes for the best health you can experience in your circumstances.
Is it safe to stop anti coag. 
Anti coagulation.
Ibuprofen and AF
New anti- coagulation drugs 
solaraze for actinic keratosis
