Warfarin Institute of America
Dedicated To Your Health
KETOPROFEN INTERACTIONS WITH WARFARIN
Brand Names: Orudis, Orudis KT, Oruvail
There is nothing published lately in the medical literature reporting on patients being harmed by this interaction. Since it is available without prescription, I would think that if this interaction was very likely to result in harm, there would be more published reports.
In 1988 Flessner et at. reported an increase in the prothrombin time and gastrointestinal bleeding with warfarin and ketoprofen. That there was bleeding, we cannot dispute. However, in 1998, the INR system was not in wide use. It is more likely that the increased PT was due to a change in the sensitivity of the materials used in the test than from ketoprofen.
Ketoprofen is known to decrease platelet adhesion and aggregation. This will cause a prolonged bleeding time. It does not affect platelet count, prothrombin time, partial thromboplastin time or thrombin time.
Miezczak and Winther, in 1993, on a double-blind placebo-controlled study with 15 healthy, male volunteers that ketoprofen had no significant effect on the anticoagulant effect of warfarin.
My recommendation is that this combination be avoided if at all possible. If it must be used, that patient should be warned that ketoprofen alone can cause gastrointestinal bleeding. If that happens, warfarin will surely make this worse. I would most assuredly recommend against it for anyone who had a history of gastrointestinal bleeding.
References:
Flessner MF et al. Prolongation of prothrombin time and severe gastrointestinal bleeding associated with combined use of warfarin and ketoprofen. JAMA 1988;259:353.
Wilson FS. Bleeding in a patient receiving warfarin and ketoprofen. JAMA 1988;259:2999.
Mieszczak C. et al. Lack of interaction of ketoprofen with warfarin. Eur J Clin Pharmacol. 1993;44:205-6.
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Last updated November 13, 2004