Naproxen Safety in Post-Stroke Patients on Eliquis

Primary Concern: Bleeding Risk

• The European Society of Cardiology identifies concurrent use of antiplatelet or anticoagulant medications with NSAIDs as a factor that increases bleeding risk, especially gastrointestinal bleedings 2
• Concurrent use of antiplatelet or anticoagulant medications with NSAIDs is a documented predictor of inappropriate prescribing and bleeding complications 1
• The American College of Chest Physicians recommends apixaban for patients with prior bleeding history due to its lower bleeding profile compared to warfarin, but adding an NSAID negates this safety advantage 3

Secondary Concern: Stroke Recurrence

• No facts are available for this section that meet the criteria

Clinical Algorithm for Pain Management

• The American College of Chest Physicians suggests avoiding all oral NSAIDs, particularly naproxen, ibuprofen, and diclofenac, in anticoagulated patients 3
• If an NSAID is absolutely necessary, the European Society of Cardiology and Thrombosis Research suggest using the lowest effective dose for the shortest duration possible, with close monitoring for bleeding complications and consideration of temporary anticoagulation adjustment in consultation with neurology/cardiology 1

Critical Pitfalls to Avoid

• Post-stroke patients remain at elevated risk for both recurrent ischemic and hemorrhagic events, and anticoagulation is specifically indicated for this ongoing risk, according to the American Heart Association/American Stroke Association 4, 5
• The European Society of Cardiology and Thrombosis Research warn that gastrointestinal bleeding risk should not be overlooked, as it is the most common site of major bleeding with NSAID-anticoagulant combinations 1, 2