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So it has. Well, I've been busy, although not so busy that I couldn't read the flists. I stumbled across a post regarding the use of acetaminophen for pain control in someone with a scrape, who then complained that she was bleeding excessively because of the med. I pondered this for a bit, then decided I had to write a little PSA on NSAIDS and acetaminophen (also known as APAP or -- for our cousins across the border and the pond -- paracetamol).
First of all, APAP isn't an NSAID. Aspirin, ibuprofen, ketoprofen, nalidixic acid, and others are all NSAIDs, or non-steroidal anti-inflammatory drugs. APAP isn't an anti-inflammatory, and it is a centrally-acting analgesic in a way that aspirin (aka ASA) and the others cannot act. In other words, APAP acts on the brain (central nervous system) in addition to the peripheral nervous system, and reduces pain perception in the brain rather than reducing pain signals along the nerve endings.
Recent publications seem to indicate that APAP works on the prostaglandin pathways just like the NSAIDs do, but reversibly and only on one of the enzymes. Somehow this translates to a central analgesic effect, so there must be something binding somewhere in the brain.
NSAIDs are known for their unwanted effects. Allow me to get on my soapbox for a second: there are no such things as "side effects" -- this term was an attempt to minimize the effects that you weren't supposed to know about or think about. All effects are equally shaped; the appearance of unwanted effects depends on many factors -- mainly within the patient -- but doesn't make them less likely than the main effect. Under the heading of unwanted effects are the two main categories, benign and adverse. An example of these effects: aspirin is very good at stopping a headache; however, at the same time it can slow your platelet function and it can cause ringing in the ears. Depending on how healthy you are, the platelet dysfunction may not be notable at all; the ringing in your ears may be more noticeable. Unwanted, yes -- but not necessarily adverse. Nothing "side" about those effects, though.
Anyways. Where was I? Oh, unwanted effects of NSAIDs (and APAP): almost all of them are known to affect platelet function. Why is this important? Let's go look at hemostasis for a minute.
Hemostasis is the control of bleeding, essentially. When you get a cut or break, the first step in hemostasis is vascular spasm -- your capillaries and arterioles will squeeze shut if possible. This slows the rate of blood loss, if you're in good luck.
The next step in hemostasis: platelet aggregation. Platelets or thrombocytes are not complete cells but bits of cell that were made from a thromboblast. They float around in the bloodstream and clump together when told to do so. When there's a break in the vascular wall, signals go out from the damaged site and induce clumping of the platelets, plus a few other things too.
Platelets act as a mortar or spackle on the site, and for small injuries this might be all that is needed. At the same time, though, they add to the chemical signals going out for clotting.
The third part of hemostasis: the clotting cascade. This is a series of cascading events triggered by chemical signals and produces fibrin, which seals off any damaged site. Fibrin sits in the break, and acts as a scaffolding for repair as well.
Now, if you're a normal human being, taking an NSAID or APAP will not appreciably slow down any response to injury. You won't be bleeding excessively if you take something after scraping your shins.
If you've got a borderline condition in which your platelets don't really function all that well, then you can expect to bleed more easily after taking an NSAID (depending on which one, as they don't all do the same things). This doesn't affect the clotting cascade, but does prolong the bleeding time. People with von Willebrand's disease don't take NSAIDs for that reason; this condition results in reduced platelet function even before taking a painkiller.
So, when someone says she had a lot of bleeding through the bandages after taking an OTC painkiller (which was IIRC something with APAP), then I'd be very suspicious of a borderline condition of the platelets. It's worthwhile following up with a doctor, to be sure.
Then again, when you've got a large area of skin loss, it's more difficult to control bleeding anyway. Proper bandaging is critical for control of this injury. Whichever it was, I'm sure it was a painful and uncomfortable few days until the skin healed enough.
Feel free to ask questions. The doctor's office is open.
Oh, and the userpic? That's Ebola virus, which causes severe uncontrollable bleeding, high fever, and usually death (depending on the strain).
First of all, APAP isn't an NSAID. Aspirin, ibuprofen, ketoprofen, nalidixic acid, and others are all NSAIDs, or non-steroidal anti-inflammatory drugs. APAP isn't an anti-inflammatory, and it is a centrally-acting analgesic in a way that aspirin (aka ASA) and the others cannot act. In other words, APAP acts on the brain (central nervous system) in addition to the peripheral nervous system, and reduces pain perception in the brain rather than reducing pain signals along the nerve endings.
Recent publications seem to indicate that APAP works on the prostaglandin pathways just like the NSAIDs do, but reversibly and only on one of the enzymes. Somehow this translates to a central analgesic effect, so there must be something binding somewhere in the brain.
NSAIDs are known for their unwanted effects. Allow me to get on my soapbox for a second: there are no such things as "side effects" -- this term was an attempt to minimize the effects that you weren't supposed to know about or think about. All effects are equally shaped; the appearance of unwanted effects depends on many factors -- mainly within the patient -- but doesn't make them less likely than the main effect. Under the heading of unwanted effects are the two main categories, benign and adverse. An example of these effects: aspirin is very good at stopping a headache; however, at the same time it can slow your platelet function and it can cause ringing in the ears. Depending on how healthy you are, the platelet dysfunction may not be notable at all; the ringing in your ears may be more noticeable. Unwanted, yes -- but not necessarily adverse. Nothing "side" about those effects, though.
Anyways. Where was I? Oh, unwanted effects of NSAIDs (and APAP): almost all of them are known to affect platelet function. Why is this important? Let's go look at hemostasis for a minute.
Hemostasis is the control of bleeding, essentially. When you get a cut or break, the first step in hemostasis is vascular spasm -- your capillaries and arterioles will squeeze shut if possible. This slows the rate of blood loss, if you're in good luck.
The next step in hemostasis: platelet aggregation. Platelets or thrombocytes are not complete cells but bits of cell that were made from a thromboblast. They float around in the bloodstream and clump together when told to do so. When there's a break in the vascular wall, signals go out from the damaged site and induce clumping of the platelets, plus a few other things too.
Platelets act as a mortar or spackle on the site, and for small injuries this might be all that is needed. At the same time, though, they add to the chemical signals going out for clotting.
The third part of hemostasis: the clotting cascade. This is a series of cascading events triggered by chemical signals and produces fibrin, which seals off any damaged site. Fibrin sits in the break, and acts as a scaffolding for repair as well.
Now, if you're a normal human being, taking an NSAID or APAP will not appreciably slow down any response to injury. You won't be bleeding excessively if you take something after scraping your shins.
If you've got a borderline condition in which your platelets don't really function all that well, then you can expect to bleed more easily after taking an NSAID (depending on which one, as they don't all do the same things). This doesn't affect the clotting cascade, but does prolong the bleeding time. People with von Willebrand's disease don't take NSAIDs for that reason; this condition results in reduced platelet function even before taking a painkiller.
So, when someone says she had a lot of bleeding through the bandages after taking an OTC painkiller (which was IIRC something with APAP), then I'd be very suspicious of a borderline condition of the platelets. It's worthwhile following up with a doctor, to be sure.
Then again, when you've got a large area of skin loss, it's more difficult to control bleeding anyway. Proper bandaging is critical for control of this injury. Whichever it was, I'm sure it was a painful and uncomfortable few days until the skin healed enough.
Feel free to ask questions. The doctor's office is open.
Oh, and the userpic? That's Ebola virus, which causes severe uncontrollable bleeding, high fever, and usually death (depending on the strain).
