Direct Oral Anticoagulants, COX-2–Selective NSAIDs, and Gastrointestinal Bleeding in Atrial Fibrillation

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NSAIDs can cause gastrointestinal (GI) bleeding, increasing the risk up to four times compared to nonuse.
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COX-2 selective NSAIDs, such as celecoxib, can reduce the risk of GI bleeding by up to 60% compared to nonselective NSAIDs.
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There is limited data on GI bleeding risks in patients with nonvalvular atrial fibrillation using direct oral anticoagulants (DOACs) and NSAIDs.
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The study utilized data from the UK Clinical Practice Research Datalink and the Régie de l’assurance maladie du Québec from 2011 to 2020.
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The cohort included patients with atrial fibrillation who initiated concomitant use of DOACs and NSAIDs, with specific inclusion and exclusion criteria.

Jama Network Open

by Fabian Maximilian Meinert, Jenny Dimakos, Ying Cui, Kristian B. Filion, Christel Renoux, Antonios Douros
May 26, 2026

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