If you’re being treated for a heart condition, medicine cabinet staples such as aspirin and ibuprofen may not be good for you. The same goes for certain antibiotics.
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Studies have found that these common medications can increase risk of bleeding, clotting, arrhythmia and even death for some heart patients. Know the risks before you take:
1. Aspirin. If you’re on blood thinners, beware of aspirin. Aspirin combined with antiplatelet drugs (such as clopidogrel [Plavix®]) and anticoagulants (such as warfarin [Coumadin®]) increases your risk of bleeding, showed a study called the WOEST trial.
“Typically, a patient who has had a stent procedure is placed on an antiplatelet drug and aspirin,” says Stephen G. Ellis, MD, Head of Invasive/Interventional Cardiology at Cleveland Clinic. “But if they are also taking an anticoagulant — for atrial fibrillation or because they’ve had valve replacement, for example — they may be safer without aspirin.”
While all three medicines help prevent blood clots, taking them at the same time can be too much of a good thing.
In the WOEST trial, which studied angioplasty patients, researchers compared those who took anticoagulants and antiplatelet drugs with aspirin and those who took them without aspirin. Patients who took aspirin were more likely to need blood transfusions.
Moreover, those who didn’t take aspirin did not have a higher risk of stent restenosis (re-narrowing of a blood vessel), stroke, heart attack or death than those who did.“All stent patients must take antiplatelet medication to help maximize the success of their procedure. It’s very important,” stresses Dr. Ellis. “But taking aspirin isn’t always necessary — especially if you’re also taking an anticoagulant.”
If you take blood thinners, talk with your doctor before taking aspirin as well.
2. NSAID pain relievers, such as naproxen and ibuprofen. If you have atrial fibrillation (irregular heartbeat) and are on blood thinners to lower your risk of blood clots and stroke, beware of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include common pain relievers naproxen (Aleve®) and ibuprofen (Advil®).
“These drugs, which are available over the counter and are used commonly to relieve the aches and pains that all of us have, are also blood thinners,” says Steven Nissen, MD, Chair of Cardiovascular Medicine at Cleveland Clinic. “If you combine them with prescription blood thinners you could have serious bleeding.”
One Danish study recently reported the link between NSAIDs and bleeding and clotting but did not determine if NSAIDs were the direct cause.
Until more studies can be done, ask your doctor about using NSAIDs for pain relief, even for brief periods.
3. Certain antibiotics. If you are at high risk for arrhythmia, beware of certain types of antibiotics. Some can disrupt the heart’s electrical activity and lead to a (sometimes lethal) rapid heartbeat.
Azithromycin (Z-pak) is one popular antibiotic that multiple studies have linked to an increase in arrhythmia-related cardiovascular deaths. Levofloxacin has shown a similar risk.
Amoxicillin and ciprofloxacin have shown lower risks.
“Usually, arrhythmia is triggered by multiple factors, not just an antibiotic,” says Dr. Nissen. “The risk of a dangerous effect from an antibiotic is highest in people who have heart disease. But everyone should be aware of it.”