Table 5.

Suggested management strategies for oral anticoagulant pharmacodynamic drug interactions

APT84

Use combination anticoagulant-APT for shortest duration possible; if continuing combination therapy, regularly reassess appropriateness of both anticoagulant and antiplatelet

NSAIDs90,91

Routinely assess and document both prescription and nonprescription NSAID use; educate patients about the risks of bleeding, and if no other alternative exists, use NSAIDs for the shortest duration possible; if long-term combined anticoagulant-NSAID use is required, consider a COX-2–specific agent or adding a gastroprotective agent

Serotonin-modifying agents92

Magnitude of bleeding risk remains unclear; weigh risk and benefit of anticoagulant-serotonergic use, especially when other risk factors for bleeding are present (e.g., advanced age, renal impairment, other interacting drugs, history of bleeding)