An alcoholic patient with liver cirrhosis requires pain management after oral surgery. The dentist considers prescribing ibuprofen. Why should ibuprofen be AVOIDED in this patient?

Correct answer: D. Cirrhosis impairs platelet function and clotting factors; NSAIDs further inhibit platelet aggregation and increase GI bleeding risk

• A. Ibuprofen is not classically hepatotoxic in the same way that acetaminophen is with alcohol. The primary concern with NSAIDs in cirrhosis is bleeding risk and hepatorenal syndrome.
• B. NSAIDs do not accelerate alcohol metabolism. They affect prostaglandin synthesis and platelet function.
• C. While drug interactions exist, the primary reason to avoid NSAIDs in cirrhosis is the GI bleeding risk from impaired coagulation and platelet function.
• D. CORRECT. In liver cirrhosis: (1) platelets are reduced (thrombocytopenia from splenic sequestration), (2) clotting factors are reduced (liver manufactures factors II, VII, IX, X), (3) portal hypertension creates varices at risk of bleeding. NSAIDs (ibuprofen) FURTHER INHIBIT platelet aggregation via COX-1 inhibition, dramatically increasing the risk of GI hemorrhage in patients already prone to bleeding. Additionally, NSAIDs can precipitate hepatorenal syndrome in cirrhosis.