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Analgesic use before and after oral anticoagulant initiation—a population-based study in Finland

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

Due to potential drug-drug interactions and subsequent bleeding risk, analgesic use should be reviewed when an oral anticoagulant is initiated. The aim of this study was to compare use of non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics before and after oral anticoagulant initiation.

Methods

All individuals who initiated warfarin, dabigatran, or rivaroxaban between January 2012 and September 2013 were identified from the Finnish Prescription Register. Prevalence of analgesic use during 3 months after oral anticoagulant initiation was compared to analgesic use during 4 months before initiation. Analgesics included were NSAIDs, paracetamol, paracetamol in doses ≥2 g/day, tramadol, and other opioids. Conditional logistic regression was used to calculate odds ratios (OR) with 95 % confidence intervals (CI).

Results

In total, 54,025 initiated warfarin, 16,894 rivaroxaban, and 1569 dabigatran. The odds of NSAID use decreased among warfarin initiators (odds ratio (OR) 0.10; 95 % confidence interval (CI) 0.09–0.10); 2.6 % used NSAID after initiation. In contrast, the odds of NSAID use increased among rivaroxaban (OR 3.56; 95 % CI 3.37–3.75) and dabigatran initiators (OR 1.44; 95 % CI 1.16–1.78). The proportions using NSAIDs after the initiation were 69 and 32 %, respectively. However, NSAID use decreased among dabigatran initiators with confirmed atrial fibrillation (OR 0.46; 95 % CI 0.23–0.92) and among rivaroxaban initiators with a daily dose of ≥15 mg (OR 0.28; 95 % CI 0.19–0.40).

Conclusions

The use of NSAIDs decreases extensively among warfarin initiators which is encouraging. However, the use of NSAIDs increases among rivaroxaban and dabigatran initiators. This is a concern as the bleeding risk may increase due to potential pharmacodynamic interactions.

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Acknowledgments

The authors would like to acknowledge Dr. Kris Jamsen at Monash University, Centre for Medicine Use and Safety, for his help producing the graphs.

Funding

We would like to acknowledge State funding for university-level health research (Grant L 3820 for Turku University Hospital) and the Social Insurance Institution of Finland (Grant 11/26/2012 for the University of Turku). Dr Jenni Ilomäki was supported by the National Health and Medical Research Council (Australia) fellowship.

Conflict of interest

The authors declare that they have no conflict of interest.

Author’s contributions

Jenni Ilomäki, Arja Helin-Salmivaara, Risto Huupponen, and Maarit Jaana Korhonen designed the study. Jenni Ilomäki, Maarit Jaana Korhonen, and Maria Rikala analyzed the data, and Jenni Ilomäki drafted the first version on the manuscript. All authors took part in interpretation of the data and gave critical comments to the manuscript. All authors approved the final version of the manuscript.

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Authors and Affiliations

  1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, 3021, Melbourne, VIC, Australia

    Jenni Ilomäki & Carl M. Kirkpatrick

  2. Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland

    Arja Helin-Salmivaara, Risto Huupponen, Maria Rikala & Maarit Jaana Korhonen

  3. Unit of General Practice, Hospital District of Helsinki and Uusimaa, Helsinki, Finland

    Arja Helin-Salmivaara

  4. Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland

    Risto Huupponen

  5. Department of Public Health, University of Turku, Turku, Finland

    Maarit Jaana Korhonen

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  1. Jenni Ilomäki
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Correspondence to Jenni Ilomäki.

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Ilomäki, J., Helin-Salmivaara, A., Huupponen, R. et al. Analgesic use before and after oral anticoagulant initiation—a population-based study in Finland. Eur J Clin Pharmacol 71, 723–732 (2015). https://doi.org/10.1007/s00228-015-1836-9

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  • DOI: https://doi.org/10.1007/s00228-015-1836-9

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