Most studies on the use of selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with hemophilia show no significant increase in bleeds or cardiovascular events with the use of these medications, according to a new review published in Blood Reviews. The authors noted that older studies with a high risk of bias and other reporting problems hindered the ability to draw firm conclusions.

“An overview of the safety profile on both adverse bleeding events and cardiovascular events of selective and non-selective NSAIDs in patients with hemophilia is currently missing,” the authors explained. “In this systematic review we aimed to give a complete overview of all publications reporting on NSAIDs and safety in patients with hemophilia.”

The authors searched the Pubmed, Cochrane, and Embase databases and ultimately reviewed 19 articles from 2017 to the present on bleeds or cardiovascular events in patients with hemophilia undergoing treatment with NSAIDs.

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The results revealed no significant increase in bleeding or cardiovascular events with the use of NSAIDs, including selective cyclo-oxygenase inhibitors and aspirin; however, the risk of bias, limited data, and poor study design in some studies limited the team’s ability to draw solid conclusions.

Based on the low cost, availability, and effectiveness of these medications in addition to their possible joint protective effects, the authors recommend larger, randomized controlled clinical trials including older patients to further assess their safety. In addition, they suggest including examinations of joint health in these trials to investigate the potential in vivo joint protective effect of NSAIDs.


van Bergen EDP, Monnikhof M, Lafeber FPJG, Schutgens REG, Mastbergen SC, van Vulpen LFD. The fear for adverse bleeding and cardiovascular events in hemophilia patients using (non-)selective non-steroidal anti-inflammatory drugs: a systematic review reporting on safety. Blood Rev. Published online June 24, 2022. doi:10.1016/j.blre.2022.100987