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Acquired Platelet Dysfunction

by David J. Kuter, MD, DPhil

Acquired platelet dysfunction, which is common, may result from aspirin, other NSAIDs, or systemic disorders.

Acquired abnormalities of platelet function are very common. Causes include

  • Drugs

  • Systemic disorders

  • Cardiopulmonary bypass

Acquired platelet dysfunction is suspected and diagnosed when an isolated prolongation of bleeding is observed and other possible diagnoses have been eliminated. Platelet aggregation studies are unnecessary.


Aspirin, other NSAIDs, and inhibitors of the platelet P2Y12 ADP receptor (eg, clopidogrel, prasugrel, ticagrelor) may induce platelet dysfunction. Sometimes this effect is incidental (eg, when the drugs are used to relieve pain and inflammation) and sometimes therapeutic (eg, when aspirin or the P2Y12 inhibitors are used for prevention of stroke or coronary thrombosis).

Aspirin and NSAIDs prevent cyclooxygenase-mediated production of thromboxane A 2 . This effect can last 5 to 7 days. Aspirin modestly increases bleeding in healthy people but may markedly increase bleeding in patients with underlying platelet dysfunction or a severe coagulation disturbance (eg, patients receiving heparin, patients with severe hemophilia). Clopidogrel, prasugrel, and ticagrelor all can markedly reduce platelet function and increase bleeding.

Systemic disorders

Many disorders (eg, myeloproliferative and myelodysplastic disorders, uremia, macroglobulinemia, multiple myeloma, cirrhosis, SLE) can impair platelet function.

Uremia prolongs bleeding via unknown mechanisms. If bleeding is observed clinically, bleeding may be reduced with vigorous dialysis, cryoprecipitate administration, or desmopressin infusion. If necessary, increasing the Hb concentration to > 10 g/dL by transfusion or by giving erythropoietin also reduces bleeding.

Cardiopulmonary bypass

As blood circulates through a pump oxygenator during cardiopulmonary bypass, platelets may become dysfunctional, prolonging bleeding. The mechanism appears to be activation of fibrinolysis on the platelet surface with resultant loss of the glycoprotein Ib/IX binding site for von Willebrand factor. Regardless of platelet count, patients who bleed excessively after cardiopulmonary bypass are often transfused with platelets. Giving aprotinin (a protease inhibitor) during bypass may preserve platelet function and reduce the need for transfusion.

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