MajorDirect thrombin inhibitor×Non-steroidal anti-inflammatory drugs (NSAIDs)
Updated · Methodology
Mechanism
Dabigatran inhibits thrombin while ibuprofen damages gastric mucosa and blocks platelet aggregation, so two bleeding pathways add up. The label separates two scenarios: short-term NSAID analgesia was not linked to more bleeding, whereas with chronic use in the RE-LY study NSAIDs raised bleeding risk by about 50 % with both dabigatran and warfarin.
Symptoms
Black stools, coffee-ground vomit, gum or nose bleeding that is slow to stop, large bruises without trauma, pink urine. Fatigue and pallor point to anaemia from slow bleeding. Impaired renal function multiplies the risk, since dabigatran is cleared by the kidneys.
Management
For occasional pain, paracetamol replaces ibuprofen without touching coagulation. If an NSAID is needed, use the shortest course with gastric protection, watching stools and haemoglobin. Continuous ibuprofen alongside dabigatran should be reconsidered: that is exactly the scenario with the extra 50 % risk.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica Ibuprofeno Cinfa 600 mg comprimidos recubiertos con película EFG (2024)– AEMPS, CIMA, nº registro 70039, secciones 4.4 y 4.5
- AEMPS: Ficha técnica Dabigatrán etexilato Cinfa 150 mg cápsulas duras EFG (2025)– AEMPS, CIMA, nº registro 88691, sección 4.5, tabla 9