Medications and other substances that may increase the risk of bleeding or bruising

Drug class or substance	Mechanism
Anticoagulants	Interfere with clot formation (secondary hemostasis)
Antiplatelet agents, including NSAIDs	Interfere with platelet function (primary hemostasis)
Glucocorticoids	Interfere with vascular integrity
Antibiotics	Cause vitamin K deficiency, especially with longer use Some interfere with platelet function
SSRIs	Interfere with platelet function (primary hemostasis)
Alcohol	Complications of liver disease may affect clot formation and may cause thrombocytopenia May cause thrombocytopenia due to direct marrow toxicity
Vitamin E	Interferes with vitamin K metabolism in some individuals
Garlic	Interferes with platelet function in some individuals
Gingko biloba	Unknown

This is a partial list that does not include drugs used for cancer therapy or drugs that alter the metabolism of anticoagulants. The magnitude of increased bleeding risk depends on many factors including the patient's other bleeding risk factors and the specific drug, dose, and duration of use. Fish oil is often cited, but bleeding risk does not appear to be increased. Refer to drug information monographs and UpToDate topics for further information.

NSAIDs: nonsteroidal antiinflammatory drugs; SSRIs: selective serotonin reuptake inhibitors.

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Medications and other substances that may increase the risk of bleeding or bruising