Over the counter anticoagulants

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Over-the-Counter Anticoagulants: Types and Common Use

Over-the-counter (OTC) anticoagulants are not available in the same way as prescription anticoagulants like warfarin, apixaban, or rivaroxaban. However, some OTC products, such as aspirin and certain dietary supplements, have anticoagulant or antiplatelet effects and are commonly used by the public for cardiovascular health or pain relief 25. These products can increase bleeding risk, especially when used with prescription anticoagulants 25.

Drug, Food, and Herbal Interactions with Anticoagulants

Both traditional vitamin K antagonists (VKAs) like warfarin and newer direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and dabigatran can interact with OTC medications, foods, and herbal supplements. These interactions can either increase the risk of bleeding or reduce the effectiveness of the anticoagulant . For example, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, which are available OTC, can significantly increase bleeding risk when taken with anticoagulants 23. Herbal supplements and certain foods may also affect how these drugs work .

Patient Knowledge and Use of OTC Products with Anticoagulants

Many patients taking anticoagulants are not fully aware of the potential interactions with OTC products. This lack of knowledge is particularly concerning with DOACs, as these medications do not require routine monitoring, leading to less frequent contact with healthcare professionals and potentially poorer patient education . Surveys show that while about half of anticoagulant users have recently purchased OTC analgesics, the use of high-risk products like ibuprofen and aspirin is relatively rare, possibly due to awareness of bleeding risks . However, the risk remains significant, especially if patients are not properly informed 13.

Bleeding Risks and Clinical Considerations

The main clinical concern with combining OTC products and anticoagulants is the increased risk of bleeding. This risk is present with both traditional and newer anticoagulants, and is heightened by the use of OTC NSAIDs, aspirin, and certain supplements 25. Healthcare providers, including dermatologists and surgeons, need to be aware of these risks, especially when patients are undergoing procedures or have other risk factors for bleeding .

Conclusion

OTC products, including NSAIDs, aspirin, and some herbal supplements, can interact with both traditional and newer oral anticoagulants, increasing the risk of bleeding. Patient knowledge about these interactions is often limited, especially with DOACs. It is important for patients and healthcare providers to communicate about all medications and supplements being used to minimize the risk of harmful interactions and ensure safe anticoagulant therapy 1235.

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Most relevant research papers on this topic

Prevalence and Knowledge of Potential Interactions Between Over‐the‐Counter Products and Apixaban

Patients with apixaban may not be aware of potential interactions with over-the-counter products, highlighting the need for increased healthcare professional contact.

Very Rigorous Journal

2019·

23citations

·D. Tarn et al.

Old and new oral anticoagulants: Food, herbal medicines and drug interactions.

Direct oral anticoagulants (DOACs) have a superior safety profile compared to vitamin K antagonists (VKAs), but may have pharmacokinetic and pharmacodynamic interactions with drugs, foods, herbs, and over-the-counter medications.

Literature ReviewHighly Cited

2017·

209citations

·A. Di Minno et al.

Switching, Adverse Effects and Use of Over‐the‐Counter Analgesics among Users of Oral Anticoagulants: A Pharmacy‐based Survey

Inconvenience and adverse effects are the main reasons for switching oral anticoagulants and limiting daily life, while over-the-counter NSAID use is rare.

Observational Study

2017·

13citations

·M. Hellfritzsch et al.

A review of reversal of oral anticoagulants, old and new, in major bleeding and the need for urgent surgery.

Reversing oral anticoagulants is safe and effective in preventing major bleeding and requiring urgent surgery, regardless of the type of anticoagulant used.

Literature Review

2020·

48citations

·T. Milling et al.

A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons.

Novel oral anticoagulant and antiplatelet drugs are revolutionizing cardiovascular therapy, but dermatologists and dermatologic surgeons must be aware of bleeding risks in their everyday practices.

Systematic ReviewRigorous JournalHighly Cited

2015·

92citations

·Deanna G. Brown et al.

Drug Interactions Affecting Oral Anticoagulant Use

Oral anticoagulants are susceptible to drug-drug interactions, requiring careful monitoring and avoidance of strong CYP3A4 and P-gp inducers.

2022·

40citations

·Philip L. Mar et al.

Oral Anticoagulants Beyond Warfarin.

Direct oral anticoagulants (DOACs) offer practical, fixed-dose anticoagulation for many patients, but specific restrictions or contraindications may apply.

2023·

15citations

·R. Olie et al.

The Significance of Drug-Drug and Drug-Food Interactions of Oral Anticoagulation.

Direct oral anticoagulants (DOACs) are a safer alternative to vitamin K antagonists, but their use is influenced by drug interactions and potential interactions with antiplatelet agents and non-steroidal anti-inflammatory drugs.

Highly Cited

2017·

108citations

·P. Vranckx et al.

Anticoagulation reversal (vitamin K, prothrombin complex concentrates, idarucizumab, andexanet‐α, protamine)

Anticoagulation reversal agents, such as vitamin K, prothrombin complex concentrates, idarucizumab, andexanet, can help prevent and treat bleeding events caused by anticoagulants.

2024·

2citations

·Elias Bekka et al.

Towards an emerging role for anticoagulants in cancer therapy: a systematic review and meta-analysis

Anticoagulants, such as heparin and warfarin, show significant tumor growth and metastasis inhibition in pre-clinical cancer research models.

Meta-Analysis

2024·

1citation

·H. Al-Azzawi et al.

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