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Old 02-21-1999
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William Mahaffy is on a distinguished road
Tylenol and Ibuprofen's Effects on Clotting

In your excellent commentary on Yazykof's injury, you recommend Tylenol (acetaminophen) or ibuprofen/nproxen as pain relievers that do not cause bleeding. This isn't entirely true. Ibuprofen, naproxen, and aspirin are all NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), a class of drugs that can prolong or worsen bleeding because they all inhibit platelet aggregation. Aspirin is just more potent at doing this than the others. Tylenol is safe in this respect.

F. Foote
Pharmacist and sailor

Bill Mahaffy responds:

You are absolutely correct that aspirin is considered of the same medication class as ibuprofen (Motrin/Advil). They are all NSAIDs. All of these drugs work to inhibit the activity of the enzyme called cyclo-oxygenase. This in turn decreases the synthesis of prostaglandins and thromboxane. This confusing cascade of biochemical reactions results in blocking pain, reducing inflammation and decreasing the blood's ability to clot by affecting the body's platelets.

Platelets are a key blood component that initiates the clotting mechanism. When they are activated, they begin to clump together to form the very early stages of a clot. This is called platelet aggregation. All NSAIDs affect the ability of platelets to aggregate and therefore affect the clotting cascade.

But there is one major difference between aspirin and other NSAIDs. The effect of aspirin on platelet function is irreversible. The only way for the body to fully regain platelet function is to produce more platelets. This platelet regeneration takes about 7 days. The effect of other NSAIDs is reversible and, in case of ibuprofen, the platelets regain their full capability within about 24 to 36 hours. While there are some very powerful NSAIDs, in terms of anti-platelet aggregation, aspirin is still recognized as the most potent player. This is why aspirin is given in the very early stages of a heart attack.

All of this said, I would still recommend carrying all three medications on board-aspirin, ibuprofen and acetaminophen. Your crew may have different preferences for specific ailments and you can now recommend the correct medication with confidence.

As you wisely point out, there are side effects to many of our most common over-the-counter drugs. Knowing the differences and then using the medications properly is the safest, and only, way to go.

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