WFH NETWORK

Inherited Bleeding Disorders

In people with bleeding disorders, the clotting process doesn’t work properly. As a result, people with bleeding disorders can bleed for longer than normal, and some may experience spontaneous bleeding into joints, muscles, or other parts of their bodies.

Hemophilia is a bleeding disorder that affects approximately 1 in 10,000 people. People with hemophilia do not have enough clotting factor VIII or IX in their blood. As a result, they can bleed for longer than normal.

The most common bleeding disorder is von Willebrand disease (VWD). It is generally less severe than other bleeding disorders. Many people with VWD may not know that they have the disorder because their bleeding symptoms are very mild.

Rare clotting factor deficiencies are disorders in which one of several clotting factors is missing or not working properly. Less is known about these disorders because they are diagnosed so rarely. In fact, many have only been discovered in the last 40 years.

Finally, inherited platelet disorders are conditions in which platelets don’t work the way they should, resulting in a tendency to bleed or bruise.

Updated May 2012

Clotting factors are proteins in the blood that control bleeding. When a blood vessel is injured, the walls of the blood vessel contract to limit the flow of blood to the damaged area. Then, small blood cells called platelets stick to the site of injury and spread along the surface of the blood vessel to stop the bleeding.

At the same time, chemical signals are released from small sacs inside the platelets that attract other cells to the area and make them clump together to form what is called a platelet plug.

On the surface of these activated platelets, many different clotting factors work together in a series of complex chemical reactions (known as the coagulation cascade) to form a fibrin clot. The clot acts like a mesh to stop the bleeding.

Coagulation factors circulate in the blood in an inactive form. When a blood vessel is injured, the coagulation cascade is initiated and each coagulation factor is activated in a specific order to lead to the formation of the blood clot. Coagulation factors are identified with Roman numerals (e.g. factor I or FI).

Updated January 2014

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 treatment centre or physician, or consult the pharmaceutical company’s printed instructions before taking any new medication.

  • Aceclofenac
  • Acenocoumarol
  • Acetylsalicylic acid (Aspirin)
  • Citalopram*
  • Clopidogrel
  • Dexibrufen
  • Diclofenac
  • Dicoumarol
  • Escitalopram
  • Fluoxetine*
  • Fluvoxamine*
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lornoxicam
  • Meloxicam
  • Nabumetone
  • Naproxen
  • Paroxetine*
  • Phenprocoumon
  • Piroxicam
  • Sertraline*
  • Sulindac
  • Tenoxicam
  • Ticlopidine
  • 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 the documentation in other respects was weak. These have not been included in this list.

People with bleeding disorders should check with their hemophilia treatment 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)
  • Willow bark
Prepared by Sam Schulman, MD
Updated February 2010