Concurrent use of NSAIDs with oral anticoagulants has conventionally been thought to confer an increased risk of bleeding, but data from the recently reported ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; n=18 201) did not necessarily support this hypothesis. A group of nearly 17,500 subjects from the trial who did not have severe renal or liver disease were examined in relation to this issue with the primary outcome being major bleeding and the secondary outcomes being clinically relevant non-major bleeding, gastrointestinal bleeding, heart failure hospitalization, stroke or systemic embolism, and all-cause mortality. Patients with NSAID use at baseline and incident NSAID use were more likely to have a history of bleeding than never users (24.5% versus 21.0% versus 15.6%, respectively). . Incident NSAID use was associated with an increased risk of major bleeding (hazard ratio [HR], 1.61 [95% CI, 1.11–2.33]) and clinically relevant non-major bleeding (HR, 1.70 [95% CI, 1.16–2.48]), but not gastrointestinal bleeding. The risk of bleeding with anticoagulation is substantial and is added to be concurrent NSAID, a practice that this study further confirms. Read the details of the study here.