Bleeding tendency

Notify the primary care provider if the following reactions occur visual disturbances, excessive drowsiness or dizziness, sore throat, fever, skin rash, pregnancy, malaise, easy bruising, epistaxis, or bleeding tendencies. 

A common problem associated with the administration of the bile acid sequestrants is constipation. Constipation may be severe and may occasionally result in fecal impaction. Hemorrhoids may be aggravated. Additional adverse reactions include vitamin A and D deficiencies, bleeding tendencies (including gastrointestinal bleeding) caused by a depletion of vitamin K, nausea, abdominal pain, and distention. 

Thrombocytopenia is characterized by a decrease in the platelet count (<100,000/mm3). The nurse monitors patients with thrombocytopenia for bleeding tendencies and takes precautions to prevent bleeding. Injections are avoided but, if necessary, the nurse applies pressure to the injection site for 3 to 5 minutes to prevent bleeding into the tissue and the formation of a hematoma The nurse informs the patient to avoid the use of electric razors, nail trimmers, dental floss, firm... 

Unlike hemophilia, the bleeding tendency in vWD is less frequent and generally less severe. Consequently, chronic... 

Bleeding episodes Pis Onset Few weeks Symptoms TSpontaneous bleeding tendency (in joints, muscles, soft tissues, and hematuria) PI use in hemophiliac patients TPV and anticoagulants (risk of intracranial hemorrhage) Consider using a NNRTI-based regimen May require increased use of factor VIII products... 

Poort S. R., Landolfi R., Bertina R. M. Compound heterozygosity for two novel missense mutations on the prothrombin gene in a patient with severe bleeding tendency. Thromb Haemost 1997 77,610-5. 

Chronic use of resins may be associated with increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. 

Gl effects Use caution in those intolerant to salicylate because of Gl irritation, and in gastric ulcers, peptic ulcer, mild diabetes, gout, erosive gastritis, or bleeding tendencies. Salsalate and choline salicylate may cause less Gl irritation than aspirin. 

Notify the physician if fever, swollen glands, sore throat, a skin reaction, or signs of hematologic toxicity (such as a bleeding tendency, bruising, fatigue, or fever) occurs... 

These drugs include magnesium choline salicylate, sodium salicylate, and salicyl salicylate. All nonacetylated salicylates are effective antiinflammatory drugs, although they may be less effective analgesics than aspirin. Because they are much less effective than aspirin as COX inhibitors and they do not inhibit platelet aggregation, they may be preferable when COX inhibition is undesirable such as in patients with asthma, those with bleeding tendencies, and even (under close supervision) those with renal dysfunction. 

Heparin [NE] Increased bleeding tendency with aspirin, but probably not with other salicylates. 

Bleeding tendencies associated with active ulceration or overt bleeding Threatened abortion Inadequate laboratory facilities Spinal puncture... 

Deficiency of vitamin K A true vitamin K deficiency is unusual because adequate amounts are generally produced by intestinal bacteria or obtained from the diet. If the bacterial population in Ihe gut is decreased, for example by antibiotics, the amount of endogenously formed vitamin is depressed, and can lead to hypoprothrombinemia in the marginally malnourished individual (for example, a debilitated geriatric patient). This condition rcaj require supplementation with vitamin K to correct the bleeding tendency. In addition, certain second generation cephalosporins (for example, cefoperazone, cefamandole, and moxalactam) cause hypoprothrombinemia, apparently by a warfarin-like mechanism. Consequently, their use in treatment is usually supplemented with vitamin K. 

Interactions of statins with warfarin, resulting in an increased bleeding tendency, have been reported (51), including interactions of anticoagulants with both lovastatin (51) and fluvastatin (89). 

The liver is the principal metabolic organ, and hepatic disease or dysfunction may impair drug elimination. Any alteration in the serum albumin or bilirubin levels and in the prothrombin time indicates impaired liver function. Similarly, skin bruising and bleeding tendency indicate decreased production of clotting factors by the liver. 

Based on the differences between hemostasis and thrombosis mechanisms, which, even though similar, are developing through different routes, the practical point related to antithrombotic therapies is that increased concentrations of antithrombotic drugs will affect thrombosis as well as hemostasis but, as the latter is a weaker process than the former, any important increase in anticoagulant potential will produce a bleeding tendency before stopping thrombosis (26). 

Given that knock-outs of prothrombotic factors yield mice with bleeding tendencies, it follows that deletion of factors in the fibrinolytic pathway results in increased thrombotic susceptibility in mice. Plasminogen (Bugge et al. 1995 Ploplis et al. 1995), tissue plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), and the combined t-PA/u-PA knock-out (Carmeliet et al. 1994) result in mice that... 

A 66-year-old man with schizophrenia took zuclopenthixol 10 mg tds for 18 days and developed a mild leukopenia (2.9 x 109/1) and thrombocytopenia (109 x 109/1). He was asymptomatic, with no evidence of infection or a bleeding tendency. Zuclopenthixol was withdrawn, without any change in the rest of his drug therapy (glibenclamide 5 mg tds, biperiden 2 mg bd, oxazepam 10 mg tds, dipyridamole 75 mg tds, and ranitidine 150 mg/day). The leukocyte and platelet counts rose over the next 5 days. 

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