ID/CC A 28-year-old male comes to his family medicine clinic and complains of increased bruising over the past 3 days, as well as bleeding from the gums while brushing his teeth.
H PI The patient is an amateur weight lifter who recently tried to lift an excessive amount of weight but strained a muscle and has been taking indomethacin for pain. o i—i o
PE VS: normal. PE: athletic male with significant ecchymoses on ^
chest and legs bilaterally; blood pressure cuff leaves petechial §
lines on arms; blood sample site taken on his arrival for routine "
blood work has become a large ecchymosis.
Labs CBC/Lytes/UA: normal. LFTs: normal; increased PT.
Treatment Discontinue indomethacin. Vitamin K may be used in patients with an elevated PT.
Discussion NSAIDs are extensively metabolized and protein-bound.
NSAIDs inhibit the enzyme cyclooxygenase, thereby inhibiting prostaglandin production, which in turn produces their antipyretic, anti-inflammatory, and analgesic effects. Aspirin in particular is an irreversible inhibitor, and therefore the production of new platelets (about 8 days) is required before its anticlotting effects can be reversed. Moderate doses of NSAIDs can bring out subclinical platelet defects in otherwise healthy individuals.
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