{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:39:30Z","timestamp":1789799970009,"version":"4.0.1"},"reference-count":72,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T00:00:00Z","timestamp":1654646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013235","name":"NIHR Greater Manchester Patient Safety Translational Research Centre","doi-asserted-by":"publisher","award":["PSTRC\u20102016\u2010003"],"award-info":[{"award-number":["PSTRC\u20102016\u2010003"]}],"id":[{"id":"10.13039\/501100013235","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>\n                    <jats:bold>Aims:<\/jats:bold>\n                    To examine the risk of gastrointestinal (GI) bleeding, major bleeding, stroke and systemic embolism associated with prescribing nonsteroidal anti\u2010inflammatory drugs (NSAIDs) to adults receiving oral anticoagulant (OAC) therapy.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We conducted a population\u2010based cohort study in adults receiving OAC therapy using linked primary care (Clinical Practice Research Datalink GOLD) and hospital (Hospital Episodes Statistics) electronic health records. We used cause\u2010specific Cox regression models with time\u2010dependent NSAID treatment in a propensity score matched population to estimate the increased risk of GI bleeding, stroke, major bleeding and systemic embolism associated with NSAID use.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    The matched cohort contained 3177 patients with OAC therapy alone and 3177 with at least 1 concomitant NSAID prescription. Compared with OAC therapy alone, concomitant prescription of NSAIDs with OACs was associated with increased risk of GI bleeding (hazard ratio [HR] 3.01, 95% confidence interval [CI] 1.63 to 5.55), stroke (HR 2.71, 95% CI 1.48 to 4.96) and major bleeding (HR 2.77, 95% CI 1.84 to 4.19). The association with systemic embolism did not reach statistical significance (HR 3.02, 95% CI 0.82 to 11.07). Sensitivity analyses indicated that the results were robust to changes in exclusion criteria and the choice of potential confounding variables.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    When OACs are coprescribed with NSAIDs, the risk of adverse bleeding events increases and, simultaneously, the protective effect of OACs to prevent strokes reduces. There is a need for interventions that reduce hazardous prescribing of NSAIDs in people receiving OAC therapy.\n                  <\/jats:p>","DOI":"10.1111\/bcp.15371","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T01:41:58Z","timestamp":1651196518000},"page":"4789-4811","source":"Crossref","is-referenced-by-count":15,"title":["Does coprescribing nonsteroidal anti\u2010inflammatory drugs and oral anticoagulants increase the risk of major bleeding, stroke and systemic embolism?"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9028-1613","authenticated-orcid":false,"given":"Leonie S.","family":"Penner","sequence":"first","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"},{"name":"NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-056X","authenticated-orcid":false,"given":"Sean P.","family":"Gavan","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2958-915X","authenticated-orcid":false,"given":"Darren M.","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"},{"name":"Division of Pharmacy &amp; Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6393-9969","authenticated-orcid":false,"given":"Niels","family":"Peek","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"},{"name":"Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3650-0168","authenticated-orcid":false,"given":"Rachel A.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102125.2006.02698.x"},{"issue":"4","key":"e_1_2_12_3_1","first-page":"e217","article-title":"Medication\u2010related emergency department visits and hospitalizations among older adults","volume":"60","author":"Bayoumi I","year":"2014","journal-title":"Can Fam Physician"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.15.1858"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2165\/11596000\u2010000000000\u201000000"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102125.2007.03064.x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100040\u20101710592"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14833"},{"issue":"4","key":"e_1_2_12_9_1","first-page":"S15","article-title":"Upper GI risks of NSAIDs and antiplatelet agents: key issues for the cardiologist","volume":"6","author":"Johnson DA","year":"2005","journal-title":"Rev Cardiovasc Med"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2005.06.1657"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010012\u20101386\u20103"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102474\u20107\u201079"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2009.03.007"},{"issue":"1","key":"e_1_2_12_14_1","first-page":"76","article-title":"Toxicity by NSAIDs. 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