Bleeding tendencies

Notes

1. For people taking anticoagulants paracetamol is considered safer than aspirin or NSAIDs because it does not affect platelets or cause gastric bleeding. Patients should have their usual INR check planned and inform their clinician if they have been using paracetamol regularly.
2. Avoid concomitant use of NSAIDs with anticoagulants (e.g. warfarin, dabigatran) if possible. All NSAIDs can cause GI irritation and reduce platelet aggregation, which can worsen any bleeding event.
   If concurrent use is necessary be aware of the potential risks of bleeding. Consider giving gastroprotection. Liaise with the patient’s GMP if a PPI is required but is not currently prescribed.
3. Prescribe NSAIDs with caution for patients with bleeding disorders (e.g. Haemophilia, von Willebrand disease and clotting factor deficiencies). Consult with the patient’s GMP or haematologist.