Paracetamol: a haemorrhagic risk factor in patients on warfarin

Mahé, Isabelle; Bertrand, Nicolas; Drouet, Ludovic; Simoneau, Guy G.; Mazoyer, E.; Sollier, Claire Bal dit; Caulin, C; Bergmann, Jean‐François

doi:10.1111/j.1365-2125.2004.02199.x

Cited by 53 publications

(34 citation statements)

References 17 publications

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“…The combination of paracetamol and oral anticoagulant agents is not as safe as generally believed, however, and could induce profound hypocoagulation. Recently, Mahe and colleagues [13 ] have shown that paracetamol 4 g per day for 14 days induced a significant increase in international normalized ratio (INR) in patients receiving a stable treatment of warfarin, increasing the risk of bleeding associated with warfarin. Paracetamol can indeed interact with warfarin and other anticoagulants and can increase prothrombin time.…”

Section: Adequate Dosage For Postoperative Pain Treatmentmentioning

confidence: 99%

State of the art of paracetamol in acute pain therapy

Remy

Marret

Bonnet

2006

Current Opinion in Anaesthesiology

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Section: Adequate Dosage For Postoperative Pain Treatmentmentioning

confidence: 99%

State of the art of paracetamol in acute pain therapy

Remy

Marret

Bonnet

2006

Current Opinion in Anaesthesiology

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“…In several studies, the concomitant use has been reported to result in an increase in INR [15][16][17][18][19]. Contrary to these results, no paracetamol-related increase in INR values was observed in studies on healthy volunteers [20,21].…”

Section: Introductionmentioning

confidence: 85%

Adverse interaction of warfarin and paracetamol: evidence from a post-mortem study

Launiainen

Sajantila

Rasanen

et al. 2009

Eur J Clin Pharmacol

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Purpose The aim of the study was to establish the prevalence and nature of potential adverse drug combinations of warfarin in a large post-mortem toxicology database. The concomitant use of warfarin and non-steroidal anti-inflammatory drugs (NSAIDs) was of interest as these drugs have been associated with internal bleeding both in clinical and post-mortem study settings. Another purpose was to obtain facts related to the questioned safety of warfarinparacetamol and warfarin-tramadol combinations. Methods The post-mortem database was searched for a 1-year period. All warfarin-positive cases and cases containing interacting drugs, as defined by the SFINX interaction database (Swedish, Finnish, Interaction X-referencing), were included. For controls, all cases containing paracetamol or tramadol were also included, and for each warfarin-positive case, an age-, sex-and alcohol-matched control case was sourced. The contribution of anticoagulant use to the deaths was evaluated from the death certificates based on medico-legal autopsies. Results In 33% of the 328 warfarin-positive cases, at least one interacting drug was present, and paracetamol was the most abundant, accounting for 49% (n=53). When paracetamol and warfarin were detected simultaneously, the number of fatal bleeds was 4.6 and 2.7 times higher compared to paracetamol or warfarin use alone respectively. The presence of an NSAID in combination with warfarin was rare, as only six cases were identified. A majority (66%) of the post-mortem blood samples had a warfarin concentration below 0.5 mg/l, and for the rest of the cases, the mean concentration was 0.70 mg/l. Conclusions This study supports the clinical evidence suggesting that warfarin-paracetamol interactions may create significant life-threatening conditions. It also accentuates the significant role post-mortem database research can have in improving drug safety.

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“…Patients with chronic liver disease and history of drug abuse were excluded from the study. In patients on anticoagulation therapy, the international normalized ratio (INR) was closely monitored due to the paracetamol eff ect on increasing the INR 40 . Although there are side eff ects reported with the use of paracetamol, none was recorded in our study.…”

Section: Fig 1 Diff Erences In Pain Perception Between Study Groupsmentioning

confidence: 99%

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

Kurtović

Rotim

Batinica³

et al. 2017

acc

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SUMMARY -Lumbar discectomy is the most common surgical treatment for intervertebral disc extrusion. Postoperative pain is a common clinical problem that greatly aff ects the length of hospitalization, functional status and patient quality of life. Th e aim of this study was to compare the postoperative analgesic effi cacy of paracetamol administered intermittently and through patient-controlled analgesia (PCA) pump following single level lumbar discectomy. Patients who underwent elective lumbar discectomy of intervertebral disc extrusion at the L4-L5 level diagnosed by magnetic resonance of the lumbosacral spine were included in the study. Pain was assessed at regular intervals for 48 hours through a shortened version of McGill pain questionnaire translated in the Croatian language. When pain was monitored as a summarized variable for each measurement, PCA group signifi cantly stood up after 24 hours with better perception of pain compared to the intermittent group (c 2 -test, p<0.05). Adequate pain relief is an important aspect of postoperative care in spinal surgery patients. Postoperative use of paracetamol through PCA pump achieved better pain control and pain management versus postoperative use of intermittent paracetamol analgesia after lumbar discectomy.

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Paracetamol: a haemorrhagic risk factor in patients on warfarin

Cited by 53 publications

References 17 publications

State of the art of paracetamol in acute pain therapy

State of the art of paracetamol in acute pain therapy

Adverse interaction of warfarin and paracetamol: evidence from a post-mortem study

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

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