Abstract
Introduction: Oral anticoagulation with warfarin is the accepted technique for treatment and prophylaxis of thromboembolic diseases. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most broadly administered medications to control musculoskeletal pain or inflammation. besides to their antiplatelet work, NSAIDs can influence the pharmacologic activity of warfarin through their immediate interaction. High protein binding and the cytochrome P450 (CYP)-dependent clearance systems of NSAIDs can influence the serum levels of warfarin.
Aim of work: In this review, we will discuss whether using warfarin with NSAID has any effect on the pharmacokinetics and pharmacodynamics of both drugs.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: Non-steroidal anti-inflammatory drug mechanism, warfarin mechanism, adverse effects of NSAID, adverse effect of warfarin, NSAID-warfarin interaction
Conclusions: Co-administration of NSAIDs and Warfarin is a topic of debate. However, there are reasons for concern. Some NSAIDs alter hemostasis and, when combined with warfarin, may lead to an increase in bleeding time. There is also a risk of increased hepatic and renal toxicity which complicates things further. Balancing the pros and cons of this drug combination should be carefully done on a case to case basis to avoid any negative consequences.