This checklist identifies factors that can increase NSAID-related bleeding risk and the symptoms that change urgency. It does not calculate a personal probability or authorize stopping prescribed clot-prevention medicine.
Download the printable 12-page bleeding-risk checklist (PDF)
Before using naproxen, review these factors
- Prior stomach or intestinal ulcer, bleeding, perforation, anemia, or an unexplained low blood count.
- Older age, poor general health, smoking, heavy alcohol use, or a planned longer course.
- Warfarin, apixaban, rivaroxaban, dabigatran, enoxaparin, clopidogrel, prescribed aspirin, or another anticoagulant/antiplatelet medicine.
- Oral corticosteroids and serotonin-acting antidepressants such as SSRIs or SNRIs.
- Another NSAID, including ibuprofen, aspirin used for pain, or a hidden ingredient in a cold, flu, menstrual, sleep, or combination product.
- Kidney or liver disease, which may change medicine exposure, clotting, or the consequences of blood loss.
Three levels of action
Routine medication review
Ask a pharmacist before combining risk-raising medicines. Review whether naproxen is necessary, the intended duration, alternatives, and whether prescribed gastroprotection or monitoring is appropriate. Spacing interacting medicines by a few hours does not remove the underlying risk.
Prompt clinical advice
Persistent stomach pain, repeated nosebleeds, unusual bruising, fatigue, pallor, reduced exercise tolerance, or dizziness can merit review. These symptoms are not specific; a clinician may need a blood count, stool testing, or another evaluation.
Emergency assessment
Vomiting blood, coffee-ground material, black tar-like stool, heavy or uncontrolled bleeding, fainting, marked weakness, confusion, or chest/breathing symptoms should not wait. Do not take another naproxen dose while waiting to see if major bleeding stops.
Do not independently stop essential therapy
Clot-prevention medicines are prescribed to reduce heart attack, stroke, venous clot, or procedure-related risks. Abruptly stopping them can be dangerous. The prescriber or anticoagulation service should decide which medicine changes when pain treatment and bleeding risk conflict.