Apart from aspirin, all NSAIDs inhibit COX competitively, and the effects on platelet aggregation depend on the pharmacokinetic profiles of the agents. Aspirin irreversibly inhibits COX and prostaglandin synthesis for the seven- to ten-day life span of the platelet. The non-aspirin NSAIDs reversibly block COX. It is safe to proceed with central neuraxial block in patients taking these drugs, a view endorsed by the American Society of Regional Anesthesia. COX-2 is not expressed in platelets and therefore COX-2 inhibitors do not affect platelet function. They are safe when used alone, but can potentiate the effect of warfarin by increasing the prothrombin time.69 The concurrent use of other medications affecting clotting mechanisms, such as oral anticoagulants, unfractionated heparin, and low molecular weight heparin, may increase the risk of bleeding complications.

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