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Warfarin and NSAID bleeding risk — GPhC CRA MCQ

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HardDrug InteractionsWarfarin and NSAID bleeding riskGPhC CRA

A 46-year-old man buys ibuprofen for back pain. His PMR shows warfarin, bendroflumethiazide and ramipril. His last INR was 2.6 three days ago and he reports dark stools yesterday. What is the most appropriate action?

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Correct answer: A — Decline NSAID supply and refer for urgent medical assessment

Warfarin plus NSAIDs substantially increases bleeding risk, and reported dark stools may indicate GI bleeding. The immediate priority is to avoid NSAID supply and refer urgently for assessment. A PPI does not make systemic NSAID use safe in this presentation. Topical NSAID might be safer than oral treatment in some contexts, but possible bleeding symptoms require urgent clinical review rather than routine advice.

Reference: BNF; NICE CKS Anticoagulation