Bleeding

Question 1

Indications of minor bleeding (when on anticoagulants or antiplatelets):

Answer 1

Nosebleeds
Bleeding while brushing teeth
Excessive bruising

Question 2

Indications of major bleeding (when on anticoagulants or antiplatelets):

Answer 2

Hematuria
Retroperitoneal (internal - may not notice)
GI bleeding (dark, tarry stools)
Brain hemorrhage

Question 3

How to decrease bleeding risk

Answer 3

Avoid drugs that increase risk of bleeding 
Avoid alcohol
Avoid contact sports
Wear properly fitted shoes
Avoid drugs that can cause dizziness

Question 4

What are some drugs that can increase risk of bleeding and so should be avoided in patients being anticoagulated?

Answer 4

NSAIDs (ibuprofen; naproxen; diclofenac)
Antidepressants (sertraline; vanlafaxine)
Herbals (ginkgo biloba; St. John’s wort; fish oil)

Question 5

What are some PT interventions that may be contraindicated in patients being anticoagulated for risk of bleeding?

Answer 5

Debridement
Deep tissue massage
Chest percussions

Question 6

What are some things PTs should look for in patients who may be at risk for bleeding?

Answer 6

S/sx of bleeding and bruising

Pain in back, abdomen, or joints - may indicate internal bleeding

Question 7

What are some medications that are not recommended in anticoagulated patients for pain relief due to bleeding risk?

Answer 7

NSAIDs (ibuprofen; naproxen; diclofenac; indomethacin) –> GI bleeding
Salicylates (aspirin) –> GI bleeding

Question 8

What is a medication that IS recommended for pain relief in patients who are being anticoagulated?

Answer 8

Acetaminophen (Tylenol) –> not an anti-inflammatory

Question 9

Dosing - Tylenol

Answer 9

NO MORE THAN 2g/day

• 4 extra strength tablets (500mg/tab)
• 6 regular strength tablets (325mg/tab)

Question 10

What is something to be aware of if increasing the dose of acetaminophen?

Answer 10

Liver toxicity