NSAIDs inhibit platelet formation of thromboxane A2, a potent stimulator of platelet aggregation. This leads to qualitative platelet deficiencies. Most NSAIDs decrease platelet aggregation only when significant concentrations of the drug are present. Increased bleeding tendencies secondary to NSAIDs are not widely reported in the literature. However, patients taking aspirin are at risk for increased bleeding during surgery and patients maintained on coumadin are advised to avoid all NSAIDs.
NSAIDs may cause other blood disorders. Bone marrow suppression is a rare but reported hematological complication with use of NSAIDs. Aplastic anemia has been reported with almost all classes of NSAIDs, but phenylbutazone, indomethacin, and diclofenac are responsible for most cases. 10 NSAID use has also resulted in agranulocytosis, red cell aplasia, thrombocytopenia, and hemolytic anemia.
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