From the Guidelines
Meloxicam can potentially cause low platelet counts, and it is recommended to avoid its use in patients with platelet defects or thrombocytopenia. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase enzymes, which can occasionally affect blood cell production or survival, including platelets 1. According to the study published in the American Family Physician 1, the risk of clotting problems contributing to significant bleeding is a concern with NSAID use, and it is advised to avoid NSAIDs in persons with platelet defects or thrombocytopenia.
Some key points to consider when prescribing meloxicam include:
- Monitoring platelet counts regularly, especially in patients on long-term therapy 1
- Being cautious when combining meloxicam with anticoagulants, as this can increase the risk of bleeding 1
- Avoiding daily low-dose aspirin if cardiovascular risk is low, to minimize the risk of bleeding 1
- Considering alternative pain management options for patients with a history of bleeding or hematological disorders 1
It is essential to weigh the benefits and risks of meloxicam use in each patient, taking into account their individual risk factors and medical history 1. If low platelets are confirmed and attributed to meloxicam, discontinuing the medication is likely the best course of action 1.
From the Research
Meloxicam and Platelet Count
- Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), has been reported to cause thrombocytopenia, a condition characterized by low platelet count, in rare cases 2, 3.
- A study published in 2014 documented a case of an 84-year-old woman who developed immune-mediated thrombocytopenia after taking meloxicam, with her platelet count decreasing from 267 × 10(3) /mm(3) to 2 × 10(3) /mm(3) within a week 2.
- Another case report published in 2022 described a 42-year-old woman who developed acute isolated thrombocytopenia after taking meloxicam, with a platelet count of 2 (normal range: 150-350 K/mm3) 3.
Effects of Meloxicam on Platelet Function
- A randomized, double-blind, placebo-controlled trial conducted in 2002 found that meloxicam did not significantly affect platelet aggregation or bleeding time in healthy adults, even at supratherapeutic doses 4.
- A study published in 1999 found that meloxicam, at a dose of 15 mg/day, spared platelet function in healthy volunteers, with no significant reduction in platelet aggregation or increase in bleeding time 5.
- However, a study published in 2014 found that meloxicam inhibited platelet aggregation and prolonged activated partial thromboplastin time (aPTT) in human blood samples, although the clinical significance of these findings is unclear 6.
Clinical Implications
- Healthcare providers should be aware of the potential risk of thrombocytopenia associated with meloxicam use, particularly in patients with a history of bleeding disorders or those taking other medications that may affect platelet function 2, 3.
- Patients taking meloxicam should be monitored for signs and symptoms of thrombocytopenia, such as bruising, bleeding, or petechiae, and their platelet count should be checked regularly 2, 3.