Bleeding and Bruising After Acupuncture: Blood Thinners and Bleeding Disorders

Get urgent help first

Call 911 in the United States for bleeding that will not stop, a rapidly growing swelling, or sudden severe pain, weakness, numbness or trouble breathing after acupuncture. For a growing, hard or very painful bruise, call your doctor the same day. Do not stop a prescribed blood thinner on your own. The NHS advises not stopping any prescribed medicine without first talking to your doctor. [1]

What the NHS says

The NHS states that acupuncture may not be safe if you are taking blood thinning medicine or are at increased risk of bleeding. [1] That is a cautious statement. It tells you to discuss it first rather than to avoid acupuncture in all cases. The research below is why the topic is debated.

People taking blood thinners: what studies found

Systematic review of anticoagulated patients (2015). The reviewers found 11 reports that met their criteria: 2 randomized trials, 4 case series and 5 case reports. [5] Seven reported well enough to assess, covering 384 anticoagulated patients and 3,974 treatments, with one moderate bleeding event (a large hip hematoma). [5] They concluded acupuncture appears safe in anticoagulated patients if needling location and depth are appropriate, and said prospective trials would help confirm this. [5] Blood-spot bleeding, which is expected with any needling and was controlled with pressure, occurred in 14.6 percent of the treatments in one case series. [5]

Prospective observational study of inpatients (2018). In 428 hospital inpatients, 169 were taking anticoagulant or antiplatelet drugs and 259 were not. [6] Mild bleeding-related events (such as micro-bleeding, hematoma and ecchymosis) occurred in 38.5 percent of the first group and 44.4 percent of the second, and the risk did not differ between groups. [6] Needle thickness was the only factor that increased risk in the multivariable analysis. [6]

Strength of evidence: promising but limited. These studies are small, mostly observational and combine different drugs, needling styles and settings. They suggest serious bleeding is uncommon, but they cannot rule out harm for a particular person. For example, the second study was done in hospital inpatients, which may differ from a community clinic.

Low platelets and bleeding disorders

Low platelet counts in cancer care. A retrospective chart review in Japan looked at people with blood cancers and low platelets (thrombocytopenia). [7] Of 2,423 acupuncture sessions in 51 patients, 815 were included in the analysis, and no bleeding event meeting the authors' definition occurred in any platelet-count group, including 90 sessions at the lowest counts. [7] The authors judged acupuncture could be performed without serious bleeding in this group. [7] Because this was a single-center chart review with many sessions excluded, treat it as an early signal only. Strength: insufficient evidence to say what is safe for you.

Hemophilia and other inherited bleeding disorders. Proper evidence not found. A PubMed search for acupuncture with hemophilia and bleeding disorders returned one small trial of acupuncture versus electrical stimulation for pain in people with hemophilia, whose abstract did not report bleeding results, so we make no safety claim. People with these conditions should speak to their hematology team before any needle treatment.

Questions to ask before treatment

• Tell the practitioner every blood thinner, aspirin, anti-inflammatory and supplement you take, and any history of easy bleeding. The NHS asks you to tell any therapist about your conditions and medicines. [1]
• Ask your prescriber whether acupuncture is reasonable for you. See coordinating acupuncture with your medical care.
• Ask what bleeding or bruising to expect and when to call.

After the session

Small marks are common. See what is normal after acupuncture and when to call and warning signs after acupuncture. For the full picture of risks, see side effects and precautions. Massage has a similar bruising topic; see massage safety.