Is Ibuprofen a Blood Thinner?

Is Ibuprofen a Blood Thinner Is Ibuprofen a Blood Thinner

Is Ibuprofen a Blood Thinner?

Ibuprofen has been a commonly used painkiller for over 4 decades. When arthritis or menstrual pain, headaches, or backaches is unbearable, the first thing most of us do is to take ibuprofen, available over-the-counter (OTC).

Ibuprofen is a well-known drug; however, if you have used it before, you probably noticed the warning that says: “Ask a doctor before use if a stomach bleeding warning applies to you, or if you have a history of stomach problems such as heartburn.” (1)

You might wonder how these warnings printed in the cartoon are linked to pills that are easily available on the shelves nearby. Does this mean that ibuprofen is a blood thinner? Don’t worry, this article will give you the answer.

Blood thinners are drugs that prevent the forming of blood clots that can cause a heart attack or stroke (2), while ibuprofen inhibits the synthesis of prostaglandins which results in an analgesic effect, swelling reduction, and fever lowering (3)(4). Yet, ibuprofen has been shown to prolong the bleeding time.

Keep reading to learn more about blood thinners, how ibuprofen affects blood clot formation and bleeding time, and find out the cautions for safely use of this traditional painkiller.

What Are Blood Thinners?

Before we answer the question if ibuprofen belongs in the blood thinners group of drugs, let’s look closer at the blood clot forming and what is the role of blood thinners.

Blood Clots: Why and How Clots Are Formed?

Blood clots are made of red and white blood cells, platelets, and fibrin. In healthy individuals, blood clots are formed when an injury occurs as a physiological mechanism that protects the body from bleeding. If clots don’t stop the flow of the blood, even a minor scrap can be dangerous to bleed to death. (5)

When a blood vessel is injured, damaged cells send signals and, through several steps, initiate clotting and stop bleeding. The signals that come to the spleen activate the release of platelets, cell fragments that help the blood clot.

Released platelets travel with the bloodstream to the place of injury, where the vessel walls capture them. Platelets activate some clotting factors, such as fibrin (a long and sticky protein) that forms a fibrin clot and holds platelets and red blood cells. Platelets pull the damaged vessel’s sides closer for easier repair.

In this way, bleeding is reduced and stopped usually in a couple of minutes. When the bleeding is stopped and the healing process begins, the body breaks down and removes the blood clot.

Anticoagulants and Anti-platelets

In some cases, formed blood clots are not dissolved as normally, the body makes more blood clots than needed, or blood clots are formed in other parts of the body than the place of injury. Such formed blood clots can travel through the blood vessels in other parts of the body, lungs, brain, and heart.

In conditions like deep vein thrombosis, pregnancy-related problems, or pulmonary embolism, blood clots can be dangerous and even life-threatening, causing stroke or heart attack. (6) (7) In the U.S., up to 100,000 people die annually of blood clots. (8)

Certain medications can reduce forming of blood clots in the vein, artery, or heart and are used to prevent severe complications. Harvard Medical School divides blood thinners into two treatment groups:

Anticoagulants – Delay the blood clotting or keep existing clots from growing bigger. Heparin, warfarin, rivaroxaban, or edoxaban are some of the anticoagulants you might hear about.

Anti-platelets – Keep blood platelets from sticking together, and by this, they don’t allow forming of blood clots. Aspirin is a well-known anti-platelet therapy. (9) (10)

The dose should be enough so the blood thinners can prevent clots, but not higher because there is a risk of more intensive bleeding than usual and losing of a high volume of blood. Because of this risk, anti-platelets and anticoagulants should be used strictly as recommended by the physician. (10)

Vitamins such as vitamin K, certain foods, and alcohol can impact the effect of blood thinners. Certain medications interfere with anti-platelets and anticoagulants. (10) Ibuprofen is one of those medicines that should be avoided while you are on anticoagulants already. (11) In such cases, before using OTC drugs, ask for a doctor’s advice.

The Role and Effects of Ibuprofen

Ibuprofen is a widely used effective painkiller known as Advil, Motrin, Cedapril, and many more names. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and has analgesic, anti-inflammatory, and antipyretic properties. As such, ibuprofen is effectively used for headache, backache, minor arthritis pain, or fever reduction as a tablet, caplet, or liquid.

Ibuprofen OTC can be found in a dose of 200-400mg. (12) However, be aware that 200mg tablets could be harmful to your health if, as with any other medicine, taken uncontrolled, in higher doses, or for a longer period than is recommended.

How Does Ibuprofen Affect the Blood?

The reason why NSAIDs should be taken with caution is the increased risk of bleeding for people on anticoagulant therapy. Dr. Judith Beizer, a Clinical Professor at St. John’s University College of Pharmacy and Health Sciences in Queens, New York, in the webinar, explains that NSAIDs interfere with platelet aggregation and can cause irritation in the gastrointestinal tract. (11)

Ibuprofen, like aspirin and other NSAIDs, blocks the formation of thromboxane A2 in the body. Tromboxane is a substance released from platelets and other body cells, and its role is to stimulate platelet aggregation, the beginning of the clot formation process. (13) If ibuprofen blocks the thromboxane A2 formation, it results in the impairment of this process and prolongs the bleeding time.  (14)

The good thing is that this effect of ibuprofen is reversible, so once ibuprofen is eliminated from the body, platelets are not affected after about 24 hours, and the aggregation process can be established again. (15)

Because of this, ibuprofen should not be used together with blood thinners if other treatments are available. (11) Ibuprofen should be taken with special care in case of gastrointestinal bleeding, ulceration, and perforation. The chances for bleeding are higher if you’re at the age 60 or older, take a steroid drug, naproxen, or have 3 or more alcoholic drinks every day while on treatment with ibuprofen. (1)

Can Ibuprofen Be Used as a Blood Thinner?

Although the effect of ibuprofen on blood clot formation is known, FDA-approved ibuprofen is to be used as a fever reducer or pain reliever only. You can use it for:

  • headache,
  • toothache,
  • backache,
  • menstrual cramps,
  • the common cold,
  • muscular aches, and
  • minor pain of arthritis. (1)

Take 1 tablet or caplet of 200mg every 4-6 hours while symptoms persist. Recommended daily dose of ibuprofen OTC is 1,200mg, or up to 3,200mg/day only if prescribed by a physician. (12)

Other Things to Be Aware of When Using Ibuprofen

Ibuprofen has other side effects that people should be aware of. Ibuprofen and other NSAIDs, except aspirin, increase the risk of heart attack, heart failure, or stroke, which could be fatal. The risk increases with higher doses and when used longer than recommended. The Drug Facts Labels of non-aspirin NSAIDs have been updated with this warning after the FDA announced the results of a comprehensive review that NSAIDs can cause heart attacks or strokes, as stated in the safety communication from 2015. (16)

Ibuprofen may cause severe allergic reactions, especially if you’re allergic to aspirin. It can also cause kidney damage or edema (retention of fluid or swelling in the legs). Ibuprofen shouldn’t be used if you have an allergic reaction to another pain reliever or fever reducer, and don’t use it right before or after heart surgery. (1)

Can Ibuprofen Be Used with Blood Thinners?

Ibuprofen is an effective pain reliever but is not recommended to be taken with blood thinners on your own due to the effect explained before that could increase the bleeding risk. (9) In case you take an anticoagulant or anti-platelet treatment, you should find another option for your pain or fever.

Diclofenac gel or acetaminophen can be an alternative option for arthritis pain for those on blood thinners treatment. (17) However, you should be careful with acetaminophen because if taken in high doses and for a long period, acetaminophen can damage the liver. (18)

Before going to buy a drug for pain or fever, check what is the active ingredient of the drug. Some OTC can contain ibuprofen in combination with other ingredients, so the combination with ibuprofen is still risky.

Ibuprofen and Aspirin?

Aspirin, as an antiplatelet drug, is used to prevent heart attack and stroke because it prevents clotting. Some studies suggest that aspirin can interact with other NSAIDs if taken together. (13) Chances are higher if ibuprofen is used with aspirin, so if you need a pain reliever, ask a doctor or pharmacist before use.

Take Home Messages

Ibuprofen is an effective and most used painkiller and fever reducer. As long as ibuprofen is taken following the warnings and recommendations, this drug can be safe.

When experiencing pain, before you go and just pick up ibuprofen from the shelf, think about if you use aspirin or anticoagulants, if you have problems with your stomach or are at risk of heart attack and stroke. If so, consult your physician first and follow the advice to use a drug that is most appropriate for your conditions.

Always check the active ingredient of the OTC product that you want to buy. Read warnings and all information available on the label and Medication Guide where you can find any issues related to the drug and FDA-approved information.

Be informed to avoid adverse events, reduce risks and properly use the benefits of this effective medicine.

References:

  1. Advil, Drug Labeling and Warning, FDA Report
  1. American Heart Association. What are Anticoagulants and Antiplatelet Agents?
  1. Mazaleuskaya Liudmila L, Theken Katherine N, Gong Li, Thorn Caroline F, FitzGerald Garret A, Altman Russ B and Klein Teri E. PharmGKB summary: ibuprofen pathwaysPharmacogenetics and genomics. 
  1. BRITISH DICTIONARY DEFINITIONS FOR PROSTAGLANDIN
  1. Blood clots: The good, the bad, and the deadly, Harvard Medical School, April 1, 2012
  1. Blood Clots, MedlinePlus, April 21, 2021
  1. Aaron W. Aday, MD, Vanderbilt University Medical Center, The Clot Connection: Thrombosis, Heart Attack, and Stroke, North American Thrombosis Forum, June 2, 2022
  1. Impact of Blood Clots on the United States, Centers for Disease Control and Prevention, June 9, 2022
  1. Bad mix: Blood thinners and NSAIDs, Harvard Medical School, December 16, 2019
  1. Blood Thinners, MedlinePlus, January 31, 2022
  1. Beizer, Clinical Professor at St. John’s University College of Pharmacy and Health Sciences in Queens, NY, Pain Relievers and Anticoagulation: What’s the Story? North American Thrombosis Forum, February 17, 2022
  1. Ibuprofen (Rx, OTC) Dosing & Uses, Medscape
  1. Dane Rucker; Amit S. Dhamoon. Physiology, Thromboxane A2, September 12, 2022, Bookshelf ID: NBK539817PMID: 30969639
  1. I. Schafer, Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis, J Clin Pharmacol 1995 Mar;35(3):209-19. doi: 10.1002/j.1552-4604.1995.tb04050.x.
  1. Gundu H. R. Rao, Gerhard G. Johnson, K. Ratnammal Reddy, and James G. White, Ibuprofen Protects Platelet Cyclooxygenase from Irreversible Inhibition by Aspirin, ARTERIOSCLEROSIS VOL 3, No 4, JULY/AUGUST 1983
  1. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes, 7-9-2015
  1. Heart-safer NSAID alternatives, Harvard Medical School, December 13, 2021
  1. Acetaminophen, MedlinePlus, January 15, 2022

See Also

Do Blood Thinners Decrease Blood Pressure?

Do Blood Thinners Affect Oxygen Levels?

What is Creatinine Level in Blood Tests?

How to Educate Levels About High Blood Pressure?

Most Popular FDA Approved Weight Loss Medications

About the Author

Biljana Srbinovska
Biljana is a Master of Pharmacy, with a Healthcare Management specialization. Over 20 years of professional engagement to enable access to innovative treatments for patients in need. Biljana is dedicated to upgrading health education evidence-based, promoting a healthy lifestyle, and embedding healthy habits.

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