Question#: 629

Question:

Hello, I just had a patient whose blood thinners were temporarily discontinued due to an episode of hematuria. Although this patient was contraindicated for NSAIDs under our analgesia directive, it got me wondering that if we have similar patients, assuming no contraindications (as in the potential bleed mentioned above) how long would a patient have to be discontinued any anticoagulation therapy before PCPs can start to consider them for NSAID treatment for pain?

Answer:

Thank you for your question. The various anticoagulants available today all have different continued anticoagulation effects and time of elimination within the body after their discontinuation. Some are two days. others a week. This is also dependent on the patient's metabolism and degree of liver/renal function which together is difficult to determine in the field. Also, in most cases anticoagulation is a treatment of the older patient population, who already have an increase risk of bleeding with NSAID use. Although small one time dosages of NSAID's are relatively low risk, it is advisable to have a conversation with the patient on the risk vs benefit of it's administration including a consultation with a BHP if necessary. This is to ensure patient consent and safety as bleeding can be a serious adverse event of NSAID therapy even in patient's who have received past anticoagulant therapy.

Hope this helps.

Thank you for your ongoing professionalism. Take care and have a safe shift.