Major
meloxicam × Warfarin
NSAID, COX-2 preferential, oxicam derivative×Vitamin K antagonist anticoagulants
Mechanism
Meloxicam (preferential COX-2 NSAID) inhibits platelet aggregation less than non-selective NSAIDs but still injures the gastric mucosa. On warfarin, bleeding risk rises moderately.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
When unavoidable, use the minimum effective meloxicam dose for short courses under pantoprazole cover. Check INR at 1 week. For chronic needs, celecoxib or paracetamol are preferable.