Individuals with bleeding disorders may require analgesics like do other patients. This includes individuals with hemophilia and joint pain associated with acute hemorrhages or chronic hemophilic arthropathy, as well as women with a bleeding disorder (e.g. von Willebrand disease) who suffer menorrhagia and menstrual pain. Although COX-2 inhibitors are not associated with platelet dysfunction in vitro, there are anecdotal reports that use of these drugs has caused clinically significant bleeding in some individuals with bleeding disorders. Whether similar risks exist with other NSAIDS, such as ibuprofen or naproxen, and whether these risks apply to individuals with bleeding disorders is not yet established.
For these reasons, caution is advised with the use of COX-2 agents (e.g. celecoxib) in individuals with bleeding disorders. Whenever possible, alernative anlgesics should be used. The National Hemophilia Foundatoion and Candadian Hemophila Foundation both recommend coution in using it. I quote: ”
1.Caution is advised with use of COX-2 inhibitors in individuals with bleeding disorders. The potential risks of gastrointestinal bleeding, heart attack, and strokes should be weighed against the potential benefits.
2. Individuals sensitive to sulfa should be aware that the COX-2 inhibitor, celecoxib (Celebrex®), contains sulfa groups which may precipitate allergic reactions.
3. Research should be conducted to determine whether alternative COX-2 inhibitors not currently available, such as refecoxib (Vioxx) which does not contain sulfa, can be safely used in lower doses in individuals with bleeding disorders.
4. Special attention should be paid to the use of COX-2 inhibitors in children, in whom thromboembolic risks remain to be assessed”.
Although Celbrex has less effect on platelets thatn traditonal nonsteroidals, it remains unexplored and I did not find studies of it in hemophila. It is not supported by guidelines.