Patient education: Managing increased bleeding risk (The Basics)

Why do I have a higher risk of bleeding? — Certain health conditions or medicines can increase your risk of bleeding.

Normally, your blood vessels seal over after an injury. The seal is made by proteins and cells in the blood. But certain things can make it hard for bleeding to stop. These include:

●Medicines called "anticoagulants" or "blood thinners" – These are used to prevent or treat blood clots. They do not actually thin the blood. They just make your blood less likely to form clots. Warfarin is an example of an anticoagulant.

●Other medicines – Some medicines, such as "NSAIDs," affect the way that platelets work. Platelets are a type of blood cell that help blood to clot. NSAIDs include aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand names: Aleve, Naprosyn). Taking these can increase your risk of bleeding, especially if you already take an anticoagulant or have a bleeding disorder. Acetaminophen (brand name: Tylenol) does not increase your risk of bleeding.

●Bleeding disorders – These include disorders of the blood clotting proteins, such as hemophilia or von Willebrand disease. They also include disorders of platelets, such as immune thrombocytopenia. Platelet disorders can affect how platelets work, or they can lower the number of platelets you have.

Sometimes, bleeding is minor, such as a nosebleed or bruising. Other types of bleeding, such as bleeding into the brain, can be very serious or even life-threatening.

Your doctor or nurse will let you know if you take a medicine or have a condition that increases your risk of bleeding. Ask questions if there is anything you don't understand.

How can I lower my risk of bleeding? — This depends on why your risk of bleeding is increased. Talk to your doctor or nurse to find out exactly what you should do.

Some general things that you can do include:

●Carefully follow all of your doctor's instructions about how to take your medicines. For example, if you take warfarin, you need to make sure that you get about the same amount of vitamin K each day.

●Avoid taking medicines that contain an NSAID unless you talk to your doctor first. Acetaminophen is generally a better option for pain or fever.

●Avoid doing things that could lead to a fall, such as walking on slippery surfaces or climbing on a ladder.

●Avoid sports that might cause injury.

●Use care when handling sharp tools, or avoid them when possible. Examples of tools that could cause serious bleeding if they cut you are sharp knives, saws, and straight-edge razors.

●Always wear a seatbelt when in a car. Wear a helmet if you ride a bicycle or motorcycle or do high-risk activities, such as skiing.

●Avoid drinking a lot of alcohol. If you drink, limit yourself to no more than 1 to 2 servings per day. A serving is equal to 1 beer (12 ounces), 1 glass of wine (5 ounces), or 1 shot of liquor (1.5 ounces). Alcohol can affect how platelets work. It can also cause problems with some anticoagulant medicines.

●If you need surgery or see a new doctor or dentist, tell them if you are at increased risk of bleeding.

What if I want to get pregnant? — If you are at risk for bleeding and want to get pregnant, talk to your doctor or nurse before you start trying. They might want to make changes to your care. For example, if you take warfarin, you might need to switch to a different anticoagulant during pregnancy. This is because warfarin can cause problems in a developing baby.

In most cases, people with a higher risk for bleeding can still have a normal pregnancy and birth. But your doctor might want to watch you more closely or make changes to your care during pregnancy.

When should I call the doctor? — Get emergency help right away (in the US and Canada, call 9-1-1) if you:

●Have a serious accident, fall, hit your head, or get another major injury that could cause bleeding

●Vomit blood or something that looks like coffee grounds

●Have a severe headache

●Have trouble talking, weakness, or cannot move 1 of your arms or legs – These can be signs of a stroke.

Call your doctor right away if you:

●Have any of these signs of abnormal bleeding:

•Nausea

•Blood in your bowel movements or dark-colored bowel movements

•Headaches or dizziness

•Nosebleeds or any bleeding that does not stop

•Dark red or brown urine

●Think that you might have a "joint bleed" – This can happen to people with hemophilia. It is when you have internal bleeding in a joint. Blood in a joint can cause pain, swelling, stiffness, and trouble moving the joint.

You should also tell your doctor if you:

●Took more of your anticoagulant medicine than you were supposed to

●Bleed from your gums after brushing your teeth

●Have heavy menstrual periods or bleeding between periods

●Have blood-filled blisters in your mouth

●Have more bruising than usual after a minor injury

●Have a rash that looks like tiny, raised bruises on your legs and feet (this is called "purpura")

What else should I know? — Your doctor or nurse can give you more information about what medicines to avoid and other ways to lower your risk of bleeding.

More on this topic

Patient education: Taking oral medicines for blood clots (The Basics)
Patient education: Hemophilia (The Basics)
Patient education: Immune thrombocytopenia (ITP) (The Basics)
Patient education: von Willebrand disease (The Basics)

Patient education: Warfarin (Beyond the Basics)
Patient education: von Willebrand disease (Beyond the Basics)