Aspirin With Blood Thinners Like Xarelto, Eliquis, Led To Increased Bleeding Risks, Few Benefits: Study

The findings of a new study suggests taking aspirin together with blood thinners like Xarelto, Pradaxa and Eliquis provides very few, if any, benefits for patients trying to prevent blood clots and strokes, yet it may significantly increases the risk of serious bleeding problems.

In a study presented at the annual meeting of the American Society of Hematology this week in Orlando, Florida, researchers from the University of Michigan indicate that patients prescribed aspirin alongside direct oral anticoagulants (DOACs), when there was not a clear need, faced more risks than benefits.

Researchers conducted a registry-based cohort study involving more than 2,000 adults already taking blood thinners, such as Xarelto and Pradaxa, for the prevention of stroke due to non-valvular atrial fibrillation, or as a prevention of venous thromboembolism (VTE) at six Michigan clinics from January 2009 through June 2019. They then looked at which patients also took aspirin in combination with the drugs and compared the two groups, looking for bleeding events, and death.

According to the findings, 31.6% of the patients were given aspirin along with the blood thinners without any clear indication for the additional treatment. The researchers looked at two groups of 639 matched patients and found that those on combination therapy had a significantly higher rate of bleeding events, particularly clinically relevant non-major bleeding (CRNMB), than those on just the blood thinners. The group on combination therapy experienced 319 bleeding events, compared to the group just taking one blood thinner, which suffered 261 bleeding events.

In addition, researchers also noted that patients on combination therapy took more trips to the emergency room and had more hospitalizations, but not at a rate they considered statistically significant.

“Adding aspirin (ASA) to a DOAC is often appropriate after acute coronary syndromes or percutaneous coronary intervention. However, many patients receive oral anticoagulation and ASA without a clear need for combination therapy,” the researchers warned. “Current data, largely from patients treated with warfarin and ASA, suggest that the addition of ASA may increase bleeding risk without reducing thrombotic events.”

Pradaxa, Xarelto and Eliquis are part of a new generation of blood thinners. However, shortly after they hit the market they were linked to serious bleeding events which were often unstoppable due to the lack of a reversal agent. The bleeding problems resulted in tens of thousands of Pradaxa lawsuits and Xarelto lawsuits, as well as some against Eliquis.

Boehringer Ingelheim, reached a Pradaxa settlement agreement with most plaintiffs in 2014. A global Xarelto settlement was reached in March 2019, resolving nearly all claims.