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Taking Aspirin With Xarelto May Increase Bleeding Risks

For decades, individuals who have a known risk for heart attack or stroke have been encouraged to take a daily low dose of aspirin to help reduce this risk. This low dose of aspirin is often referred to as “baby aspirin,” and this terminology combined with the fact that so many people use aspirin on a daily basis may lead people to form conclusions that this is a safe and effective way to reduce heart attack risk. However, recent data from the Institute for Safe Medication Practices (ISMP) suggests that combining aspirin with another common treatment for individuals at risk for heart attack, an anticoagulant like Xarelto, may significantly increase the risk of internal bleeding.

In their most recent QuarterWatch report, the ISMP shares the results of an investigation into higher-than-normal rates of adverse event reports submitted to the FDA citing internal bleeding side effects. The ISMP says, “Our interest was spurred when an unexpectedly large number of serious adverse drug events in 2016 X3 were attributed to the ubiquitous and invaluable drug aspirin.” Since aspirin has been safely used for so many years and by so many people, ISMP researchers wondered whether there was a specific reason for the recent increase in aspirin internal bleeding reports. What they found was that many of the individuals behind these reports were also taking a blood thinner like Xarelto, Eliquis, or warfarin (Coumadin).

The ISMP says, “For the most recent quarter, aspirin was the primary suspect drug in 2,134 reported cases, including 169 patient deaths and 1,137 gastrointestinal hemorrhages. In another ranking of the new quarter of data, aspirin accounted for more serious injuries to U.S. patients 75 years and older than any other therapeutic drug.”

Given the long record of safe aspirin use, the ISMP researchers doubted that this sharp increase in aspirin adverse event reports was simply an anomaly. When they looked into these data further, they realized that in 87.4% of the adverse event reports cited aspirin internal bleeding, they wondered how many of these patients were also taking a drug known to increase internal bleeding risks, such as an anticoagulant. Previous research has suggested that using a drug like Xarelto with aspirin may increase the risk of internal bleeding by as much as 15%.

Aspirin, while known by many consumers as a pain medication, is actually also a blood thinner. The American Heart Association explains how a low daily dose of aspirin may help to prevent blood clots that may lead to heart attack or stroke:

Most heart attacks and strokes occur when the blood supply to a part of your heart muscle or brain is blocked. This usually starts with atherosclerosis, a process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.

Plaque usually affects large and medium-sized arteries. Plaques can grow large enough to significantly reduce the blood’s flow through an artery. But most of the damage occurs when a plaque becomes fragile and ruptures. Plaques that rupture cause blood clots to form that can block blood flow or break off and travel to another part of the body. This is called an embolism.

  • If a blood clot blocks a blood vessel that feeds the heart, it causes a heart attack.
  • If a blood clot blocks a blood vessel that feeds the brain, it causes a stroke.

Aspirin helps prevent blood clots from forming and helps prevent heart attack and stroke.

Just as aspirin may prevent the formation of blood clots that cause heart attack and stroke, so do anticoagulant medications like Xarelto, Eliquis, Pradaxa, and warfarin. These drugs work on a different part of the clotting continuum than aspirin does, so it may be appropriate for some patients to combine these therapies. However, it is not recommended that any patient at risk for a heart attack embark on a medication regime without first discussing it with a trusted doctor, since combining blood thinners with a drug like aspirin, thought by many to be benign, can have serious or even fatal consequences.

Since the newer generation of blood thinners called Factor Xa inhibitors was introduced, these medications have been viewed by many patients as a more convenient and safer alternative to warfarin, in part because they believed the risk of internal bleeding was lower with the newer drugs. Now, however, a rapidly growing number of individuals are filing Xarelto and Eliquis lawsuits based on claims that they were not sufficiently warned of the risk of internal bleeding associated with these drugs or of the lack of a reversal agent to stop bleeding.

If you or someone you love has suffered internal bleeding while taking a drug like Xarelto, you could be entitled to compensation based on allegations that drug makers neglected to provide proper warning of risks. To learn more, please contact our attorneys to schedule a free Xarelto lawsuit consultation.