Where do those post-stent bruises come from?

by Carolyn Thomas  ♥  @HeartSisters

After being discharged home from the hospital following my heart attack, I didn’t know that one of the new heart drugs I was now taking had dramatic side effects:   technicolour bruising. All over!   One day in the shower, for example, I noticed two perfectly round small bruises on my lower abdomen, side by side, exactly the same size. Where on earth had those two distinct bruises come from? It was only much later I figured it out.  Lilly, my fluffy calico cat, would regularly “make biscuits”  before settling down for a lap nap by kneading her little paws into my lower abdomen.  Even a petite 8-pound creature could cause deep purple and blueish bruises!

Here’s why bruising like this is so commonly seen in  heart patients – even those without cats!       .      .

According to the National Institutes of Health (NIH), “almost any medication has the potential to change the way blood platelets work in the body”Platelets are the tiny disc-shaped cells in our blood that help blood to clot. This is a good thing when you cut your finger while chopping onions (because you want the bleeding to clot and form a scab)  – but NOT good when those clots form inside coronary arteries feeding oxygenated blood to the heart muscle.  So to help prevent the body from sending an avalanche of platelets to a newly implanted foreign object like a stainless steel stent inside your coronary artery, cardiologists prescribe for their heart patients anti-platelet medications (e.g. Plavix, Brilinta, Effient, aspirin, etc.)   These anti-platelet meds can also cause bleeding gums, heavier menstrual periods, or nosebleeds.

In those early days post-hospital discharge,  I went from feeling horrified to feeling fascinated by my “Plavix bruises”. They were rarely if ever painful, and would almost always suddenly appear without any memory of having hurt myself. It doesn’t take much to cause bruising when taking anti-platelet drugs. My walking buddies would say things to me like: “What happened to your ankle?” – which is when I’d notice that I must have banged into something because it had turned a freakishly unnatural colour. Even getting a pedicure resulted in bruises!  No pain, just weird bruising. Eventually, I  began to interpret my bruises as a good sign – they meant that my anti-platelet drug Plavix was clearly working to help keep clots from forming inside this newly implanted stainless steel stent in my heart.

Everyone experiences bruising at some point, as explained in the latest patient newsletter from Self-Management B.C., our provincial health agency that, among other things, runs free patient classes on managing pain and other chronic conditions. (Thank you, Canada a.k.a. “commie pinko land of socialized medicine!”) 🇨🇦

Their newsletter describes bruising as the typical result from an injury that breaks capillaries (our tiniest blood vessels). The medical term for bruising is ecchymosis.  If the skin’s surface doesn’t break, the blood from these capillaries can’t escape – and a bruise forms.   It can take weeks for bruises to fade away as the body naturally breaks down and absorbs this blood. A bruise usually starts as red, then purplish or black and blue within one to two days, followed by green or yellow for 5 to 10 days, and then a yellow-brown or light brown from 10 days to 2 weeks. Colours change as the bruise fades from hemoglobin (the iron-rich substance in the blood) breaking down into other compounds.

Dr. Deepak Bhatt, editor in chief for the Harvard Heart Letter, reminds us in general that “even slight bumps that you don’t even notice can cause bruises.”  Some of the more common reasons for bruising include:

  • some people bruise more readily than others – it runs in families
  • vitamin deficiency e.g. vitamin C (people who smoke are at significantly higher risk of vitamin C deficiency) or deficiency in vitamin K, vitamin B or zinc that can increase the likelihood of bruising
  • having a medical condition that interferes with nutrient absorption 
  • some people are more accident-prone or live in a cluttered environment, which increases the chances of falling or tripping injury
  • aging makes the skin more fragile and thinner – a combination of less subcutaneous (fat) tissue for protection and more fragile blood vessels; blood vessels lose some elasticity over time and are also more prone to breaking
  • compared to men, women tend to bruise more easily as they tend to have more delicate blood vessels, especially on the upper arms and thighs
  • people who have lots of sun exposure over the years (can weaken blood vessel walls)
  • dietary supplements such as ginkgo, ginseng or garlic can thin the blood and make it harder for blood to clot
  • unmanaged diabetes which increases the likelihood of bruises that last longer
  • having a low blood platelet count (thrombocytopenia)
  • having rheumatoid arthritis
  • those with kidney disease bruise easily due to a loss of skin elasticity
  • high alcohol intake damages the liver, which then doesn’t produce enough proteins to help blood clot
  • certain types of cancer
  • inherited bleeding disorder, e.g., hemophilia, when the body does not make enough proteins to help blood clot
  • medications – besides the anti-platelet drugs mentioned above, other drugs that can cause bruising include corticosteroids, anti-coagulants (often prescribed for people with atrial fibrillation, deep vein thrombosis, pulmonary embolism or after joint replacement surgery), aspirin, chemotherapy during cancer therapy, and some antibiotics

What to do about a bruise?

We don’t usually have to do anything to treat bruises. Taking over-the-counter pain medications might help if the bruise is painful – but remember that some of these drugs may actually increase the risk of bruising (e.g., aspirin or ibuprofen). If a bruised area becomes swollen, you could try an ice pack wrapped in a towel for short 15-minute periods (the cold slows blood flow to the area, so less blood ends up leaking into your tissues).  After about two days, you could try a heating pad or warm compress several times throughout the day.

When to see your doctor about bruising

While bruises are usually harmless, they can sometimes signify a more significant issue. The NIH lists some situations when you should see your doctor:

  • if you develop many more minor bruises or one large bruise without injury (if you’re not taking anti-platelet meds, this can be a sign that bleeding is happening inside the body)
  • if you notice red streaks around the bruise, oozing or develop a fever (signals of infection)
  • if a bruise does not go away
  • if it’s a large and very painful bruise following an injury (could mean a sprain or a broken bone)
  • if you experience increased frequency of bruises or bruising more easily
  • if you notice red, purple or painful spots on the lower legs (not arms) – could be inflamed blood vessels or vasculitis
Sources: Self-Management B.C., Harvard Medical School, Cleveland Clinic, Creakyjoints (arthritis) website, Mayo Clinic, NIH News in Health website, Medical News Today.

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NOTE FROM CAROLYN:  I wrote more about common cardiac meds (and managing side effects) in my book  A Woman’s Guide to Living with Heart Disease“.  You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

Q:  Were you surprised to see bruises due to your cardiac meds?

See also:

What you need to know about your heart medications

14 thoughts on “Where do those post-stent bruises come from?

  1. I had triple bypass surgery 8 weeks ago. It was a complete surprise to me. The bruising was one of the worst things. When I came home and saw my body, I was sick. Then being on the blood thinner did not help.

    I am off the blood thinner now. Working on cardiac rehab. And looking forward to the day I can get out of bed without my chest screaming, and showering and dressing at a faster pace.

    I just found your blog and look forward to reading more sound advice. Thank you.

    Liked by 1 person

    1. Hello Susan – welcome to the exclusive club that NOBODY ever wanted to join!

      You are still in very early days, so no wonder you are feeling overwhelmed at this point. Each day, your body is gradually healing and recuperating from major surgery – and I mean healing both physically and psychologically. A lot of healing has in fact already happened, little by little.

      Now that you’re here, you may be interested in reading three specific Heart Sisters posts: the first is about recovering from cardiac surgery (and sometimes even our surgeons offer different estimates when asked “How long will it take?”)
      The second is about learning to love your scar (which I know sounds like crazy talk right now, but keep an open mind! (You might have to re-read this one on your one-year “heart-iversary to see if it makes more sense then).

      The third is about making peace with your brave little heart – which has just gone through so much while it survived what many do not:

      As I mentioned, you are recovering both physically AND psychologically – it’s important to be patient with yourself along this path. Lots more about the psychological impact of a cardiac diagnosis here.

      Good luck to you – take care, and stay safe. . . ♥

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  2. I’ve just ordered your book on Amazon and I will certainly get my brother and sister to read it, they both have heart disease. I really want to post a question but can’t seem to find the link, can anyone please assist me on this matter – thank you so much.

    Liked by 1 person

  3. The bruises are a side effect of you taking a blood thinner and anticoagulant or anti-platelet medications. The body will adjust to the medications in the first 6 months and most will be taken off the anticoagulant and anti-platelet medications by the end of the first year. Any bruises after that is caused by the asprin.

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  4. After my pacemaker was put in, I looked like I had been in a car accident. Bruising was horrible. I was in the hospital one night and maybe had a total of 5 pain meds after the surgery. They said take Tylenol. What a joke.

    I called on a Sunday and begged for something for the pain. I don’t cry very often but cried all of the time, it hurt so bad. The nurse practitioner who called me back acted like I was just being a baby. She said patients just took Tylenol. Goody for them I thought, but this hurt like fire where the incision was. I kept putting cold cloths on the area to stop the pain. I couldn’t sleep in my bed, had to sleep in a recliner. In fact didn’t sleep in my bed for 3 weeks. I ate Tylenol like it was candy for 2 weeks which sure wasn’t good for me.

    Worst thing I have ever had done. When I went to see my cardiologist a month later, he said you must have had a hematoma.

    Liked by 1 person

    1. Ouch! That sounds dreadful, Michelle! A hematoma can be so terribly painful. And almost as bad as the physical pain is being dismissed when you tell somebody about your pain but are not believed.

      Take care, stay safe. . . ♥

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  5. I was already on low dose aspirin and warfarin for atrial arrhythmias when I had my stent placed, so I had experienced easy bruising. Like with almost every shot of insulin. However, I did find that Plavix brought the incidental bruising to a whole new level.

    At my post stent cardiology visit, the doctor complimented me on how my purple shirt matched my bruises perfectly. 😉

    A good “non- medical” treatment for bruising and swelling is to apply Arnica gel to the area.

    Liked by 1 person

    1. Hello Jill – yep, that’s my goal: to have my purple shirt match my bruises perfectly! Ha!

      Thanks for that Arnica reminder – I was going to add Arnica under the “What To Do” section, but the published research is still a bit spotty (some studies have shown “significant” bruise improvement with Arnica (sometimes sold as Bruise Gel) while others report no difference between the gel and placebo cream. But more importantly some people should apparently NOT take Arnica (e.g. those with a ragweed allergy like mine, or an allergy to other members of the Asteraceae family, or those diagnosed with inflammatory bowel disease or high blood pressure!) Maybe a good old ice-pack is still the best bet!

      Take care, stay safe. . . ♥

      Like

      1. Hi Carolyn,
        The bruises were no surprise, I was fully educated to the full extent of the medication and it’s side effect. What wasn’t told to me regarding it, I received in writing from my pharmacy. There is a full disclosure law here that says no information can be withheld. I even had the pleasure of meeting and talking to Dr. Harlan M. Krumholz. He talked with me about my condition and the rare chance of my ever being a cardiac patient and me being an anomaly. He gave me an autographed copy of his book “THE EXPERT GUIDE to BEATING HEART DISEASE”.

        What surprises me is the number of heart patients who don’t realize that the placement of a cardiac stent is major heart surgery. They don’t understand that their doctor sent them home to rest. They don’t know that that first week home they are still partly under the effects of the anesthesia. They are shocked that a week later they have no energy and only want to rest.

        As for me, I always have more questions than answers. I am one of the lucky(not) people who have a microvascular disorder giving me very tiny arteries keeping me on Plavix for as long as I have my native heart. That and the fact I have a condition called hypercoagulability and my blood is thicker then most who haven’t taken aspirin or Plavix and I take both.
        Robin

        P.S. Thank you Carolyn, I was about to look up the Arnica Gel. You saved me the trouble as I’m one of those people with a Ragweed allergy. I took a cough syrup after asking the pharmacists something I could take and ended up in the ER because of a severe allergic reaction. Thanks again.

        Liked by 1 person

        1. Hello Robin – I’m impressed that you not only met the famous Yale cardiologist Dr. Krumholz but that he also gave you an autographed copy of his book! I admire his work and have quoted his wise words a number of times here in my blog articles.

          Take care, and stay safe. . . ♥

          Like

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