NSAIDs in Patients with History of MI and on Anticoagulants

Risk Assessment and Management

The American College of Cardiology recommends that non-selective NSAIDs such as naproxen may be used in patients with history of MI only for short-term treatment when first-line alternatives are insufficient, but should be avoided in patients on anticoagulants due to significantly increased bleeding risk 1, 2
The American College of Cardiology suggests that NSAIDs increase cardiovascular risk in patients with prior MI, with risk varying by specific NSAID 1, 2
The American Academy of Family Physicians notes that the risk of GI bleeding increases 3-6 times when NSAIDs are used with anticoagulants 5
The American College of Cardiology advises against using ibuprofen in patients taking aspirin as it blocks aspirin's antiplatelet effects 1, 2

The American College of Cardiology recommends beginning with acetaminophen, small doses of narcotics, or non-acetylated salicylates as first-line options for pain management in post-MI patients 1, 2
The American College of Cardiology suggests that non-selective NSAIDs such as naproxen may be considered if first-line therapy is insufficient 1, 2

The American Academy of Family Physicians recommends maximizing non-NSAID analgesics and using proton pump inhibitor therapy if an NSAID is unavoidable in anticoagulated patients 5
The American College of Cardiology advises monitoring closely for signs of bleeding in patients on anticoagulants who are taking NSAIDs 5