Which analgesic should be AVOIDED in this patient?

In advanced cirrhosis, standard acetaminophen doses are hepatotoxic (a reduced ceiling of ~2 g/day is recommended, not 4 g), and NSAIDs are avoided because of impaired platelet function, risk of GI bleeding from varices, and renal impairment (hepato-renal syndrome). Low-dose acetaminophen is generally preferred over NSAIDs when needed. Of the two, ibuprofen is more universally avoided; high-dose acetaminophen also poses risk.