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Drugs that cause bleeding

People with bleeding disorders should avoid aspirin and other drugs that can cause bleeding. This list of drugs that can cause bleeding does not include drugs that have to be given as injections or intravenous infusions. The generic or “chemical” names are given since the brand names or marketing names differ between countries.

While every effort has been made to include as many drugs as possible, some may be missing. In addition, many non-prescription medications, such as cold remedies, contain aspirin. People with bleeding disorders should check with their hemophilia centre or physician, or consult the pharmaceutical company’s printed instructions before taking any new medication.

Fluoxetine* Lornoxicam Piroxicam
Fluvoxamine* Meloxicam Sertraline*
Ibuprofen Nabumetone Sulindac
Indomethacin Naproxen Tenoxicam
etoprofen Paroxetine* Ticlopidine
Ketorolac Phenprocoumon Warfarin

*These antidepressants have a mild inhibiting effect on the platelet function, which may increase the bleeding tendency. However, since they are less harmful than most other antidepressants in other respects, it is possible to try the medication by starting at a low dose and carefully increase it. Many patients will tolerate these drugs well.

Herbal drugs (phytomedicines) that can cause bleeding

while every effort has been made to include as many herbal drugs as possible, some may be missing. Some herbal medicines have been reported in association with bleeding, but in these cases the patient also took regular drugs that could have caused the bleeding or that the documentation in other respects was weak. These have not been included in this list.

People with bleeding disorders should check with their hemophilia centre or physician, or consult the pharmaceutical company’s printed instructions before taking any new herbal drug.

  • Ginkgo biloba
  • Garlic in large amounts
  • Ginger (not dried ginger)
  • Ginseng (Asian)
  • Feverfew
  • Saw Palmetto (Serenoa repens)

Recombinant products and gene therapy

The structure of the factor VIII gene was characterised and cloned in 1984. This led to the availability of recombinant (genetically engineered) factor VIII a decade later. The availability of safe products has stimulated the growth of prophylactic treatment, although it must be emphasized that the concept is certainly not new and was developed by Prof. Inga Marie Nilsson in Sweden in the 1950s.The rate of progress continues apace, and gene therapy is a realistic goal. However, we do not forget that many people with hemophilia around the world still receive absolutely no treatment. Perhaps the current position can best be expressed in words paraphrased from Sir Winston Churchill: this is not the end of our struggle to conquer hemophilia, and not even the beginning of the end. However, we can at least say that this is the end of the beginning of our campaign.