What conditions increase the risk of bleeding? An overview

September 30, 2025 •

4 min read

According to the National Bleeding Disorders Foundation, von Willebrand disease, the most common inherited bleeding disorder, affects approximately 1% of the U.S. population. Understanding what conditions increase the risk of bleeding is vital for diagnosis, management, and proactive care, encompassing a wide range of inherited, acquired, and medication-related factors.

Quick Summary

A variety of factors can heighten a person's bleeding risk, including anticoagulant medications, inherited disorders like hemophilia and von Willebrand disease, organ diseases such as liver and kidney failure, and certain cancers.

Key Points

Medications Impact Clotting: Common drugs like anticoagulants, antiplatelets, and NSAIDs are significant risk factors for increased bleeding by interfering with the blood's ability to clot effectively.
Inherited Disorders are Primary Causes: Genetic conditions such as hemophilia and von Willebrand disease are present from birth and are caused by deficiencies or defects in specific clotting proteins.
Organ Health is Critical: Severe liver disease can drastically reduce the production of essential clotting factors, while advanced kidney disease can impair platelet function, both leading to a heightened bleeding tendency.
Cancer and its Treatment Pose Risks: Cancers can directly cause bleeding, and therapies like chemotherapy can suppress bone marrow function, leading to dangerously low platelet counts and increased bruising or bleeding.
Diverse Acquired Conditions Exist: Beyond organ failure, other acquired issues like autoimmune diseases, nutrient deficiencies (especially Vitamin K), and systemic conditions like DIC can also severely impact the body's clotting ability.

Medications that Increase Bleeding Risk

Some of the most common causes of an increased risk of bleeding are medications. Several drug classes can interfere with the body's natural clotting mechanisms, either by inhibiting clotting factors or disrupting platelet function.

Anticoagulants (Blood Thinners): These drugs are prescribed to prevent blood clots in people with conditions like atrial fibrillation or deep vein thrombosis. Common examples include warfarin, heparin, and direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, apixaban, and edoxaban.
Antiplatelet Agents: These medications, such as aspirin and clopidogrel, prevent platelets from sticking together to form a clot. They are often used to prevent heart attacks and strokes.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter and prescription NSAIDs, such as ibuprofen and naproxen, can impair platelet function. Combining them with other blood thinners can significantly amplify bleeding risk.
Selective Serotonin Reuptake Inhibitors (SSRIs): Certain antidepressants in this class can interfere with platelet function, increasing the risk of bleeding, especially gastrointestinal bleeding.
Corticosteroids: These drugs, used to treat conditions like inflammatory bowel disease, can also raise bleeding risk.
Herbal and Other Supplements: Some supplements, including Ginkgo biloba, large amounts of garlic, and ginseng, can also increase bleeding tendencies.

Genetic and Inherited Bleeding Disorders

Inherited disorders result from genetic mutations that affect the proteins necessary for blood clotting. These conditions are present from birth and can range in severity.

Hemophilia: This is a hereditary bleeding disorder primarily affecting males. Hemophilia A involves a deficiency of clotting factor VIII, while Hemophilia B involves a deficiency of factor IX. The severity depends on the level of the missing factor, with severe cases leading to spontaneous and life-threatening bleeds.
Von Willebrand Disease (VWD): As the most common inherited bleeding disorder, VWD is caused by a defect in von Willebrand factor, a protein that helps platelets stick to the vessel wall and carries factor VIII. VWD can affect both males and females, with variable symptoms from easy bruising to heavy menstrual bleeding.
Other Rare Factor Deficiencies: Less common genetic disorders involve deficiencies in other clotting factors, such as Factors I, V, VII, or X.
Hereditary Hemorrhagic Telangiectasia (HHT): This is a rare inherited disorder causing tangles of blood vessels (telangiectasias), which can rupture and cause bleeding.

Acquired Medical Conditions Affecting Clotting

Beyond genetics and medication, several diseases and acquired conditions can disrupt the body's hemostatic (clotting) balance.

Liver Disease

The liver is crucial for producing most of the body's clotting factors. Severe liver disease, such as cirrhosis or acute liver failure, impairs this production, leading to a higher risk of bleeding. Portal hypertension, often caused by liver disease, can also cause severe gastrointestinal bleeding from enlarged veins.

Kidney Disease

Chronic kidney disease and end-stage renal disease (ESRD) can cause a complex disturbance of the coagulation system. Uremic toxins accumulating in the blood can impair platelet function, leading to a heightened bleeding tendency.

Platelet Disorders

Problems with platelets, the small cells vital for clotting, can increase bleeding risk. These include:

Thrombocytopenia (Low Platelets): Causes include chemotherapy, cancer, chronic kidney disease, or autoimmune issues like idiopathic thrombocytopenic purpura (ITP).
Platelet Function Defects: In conditions like Bernard-Soulier Syndrome or Glanzmann's Thrombasthenia, the platelets are present but don't function correctly.
Thrombocythemia (High Platelets): In very high platelet counts, the body's clotting factors can be consumed, paradoxically leading to a risk of bleeding.

Cancers and Their Treatments

Cancer itself can increase bleeding risk, especially if a tumor invades blood vessels. Chemotherapy and radiation therapy can cause thrombocytopenia (low platelets) by suppressing bone marrow production.

Vitamin K Deficiency

Vitamin K is essential for the production of several clotting factors. Deficiency can result from poor diet, malabsorption issues, or certain medications. Newborns are particularly vulnerable, which is why a vitamin K shot is often given at birth to prevent vitamin K deficiency bleeding (VKDB).

Autoimmune Diseases

Certain autoimmune conditions, including systemic lupus erythematosus (lupus) and rheumatoid arthritis, can cause acquired bleeding disorders by affecting platelet function or producing antibodies against clotting factors.

Comparison of Common Bleeding Risk Factors


Risk Factor Type	Primary Cause	Typical Bleeding Symptoms	Example Conditions
Medications	Inhibition of clotting factors or platelet function	Easy bruising, prolonged bleeding from cuts, nosebleeds, heavy menstrual bleeding	Anticoagulants (warfarin, DOACs), Antiplatelets (aspirin, clopidogrel), NSAIDs (ibuprofen)
Inherited Disorders	Genetic defect causing low or non-functional clotting factors or proteins	Spontaneous joint or muscle bleeding (severe), easy bruising, nosebleeds, heavy periods	Hemophilia A/B, von Willebrand Disease
Organ Disease	Impaired production of clotting factors or platelet dysfunction	Bleeding from puncture sites, gastrointestinal bleeding, bruising	Severe liver disease (cirrhosis), End-stage renal disease (ESRD)
Cancer/Treatment	Tumor invasion, chemotherapy-induced low platelets (thrombocytopenia)	Easy bruising, tiny purple spots (petechiae), bleeding from nose or mouth	Hematologic cancers (leukemia), solid tumors, chemotherapy

Conclusion

Understanding the diverse factors that can contribute to an increased risk of bleeding is crucial for both healthcare providers and patients. From commonly prescribed medications to rare genetic conditions and systemic diseases, the causes are numerous and complex. Conditions like liver or kidney failure, certain cancers, and nutritional deficiencies can all disturb the delicate balance of the body's hemostatic system. For individuals with known risk factors, careful monitoring and communication with a healthcare team are paramount to managing symptoms and preventing severe bleeding complications. A comprehensive understanding allows for better management and safer treatment plans across many different medical situations.

For more information on bleeding disorders, the National Heart, Lung, and Blood Institute (NHLBI) is a valuable resource.

Frequently Asked Questions

Yes, common over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can impair platelet function, increasing your bleeding risk. Always inform your doctor about all medications and supplements you take.

The liver is responsible for producing most of the proteins (clotting factors) that help blood clot. When severe liver disease occurs, the liver cannot produce enough of these factors, leading to a higher risk of bleeding.

Signs may include easy bruising, frequent or prolonged nosebleeds, excessive bleeding after a minor cut or dental work, or heavy menstrual periods. People with severe disorders like hemophilia might have spontaneous internal bleeding.

Yes, chronic kidney disease can lead to an increased tendency for bleeding. The accumulation of toxins in the blood can interfere with normal platelet function, affecting the body’s ability to form clots.

Some cancer treatments, particularly chemotherapy, can suppress the production of blood cells in the bone marrow. This can lead to a low platelet count (thrombocytopenia), which increases the risk of bleeding and bruising.

Vitamin K deficiency can cause bleeding, especially in newborns who have low levels at birth. It can also affect adults with malabsorption problems. A vitamin K shot is recommended for all newborns to prevent this potentially serious bleeding disorder.

While pregnancy can sometimes create a higher risk for bleeding, especially during and after childbirth, the body's clotting system also changes. For women with an underlying bleeding disorder like von Willebrand disease, managing bleeding risk during pregnancy requires close supervision.