To the Editor: A 47-year-old woman presented with a 1-week history of spontaneous prominent and painful bruising and haematomata, 5–6 weeks after commencing meloxicam 15 mg daily for osteoarthritis and plantar fasciitis. The bruises varied in size from 2 cm × 2 cm to 3 cm × 4 cm. She had a past history of acne rosacea, for which she was taking clonidine 100 μg daily, and reflux oesophagitis, for which she was taking pantoprazole 40 mg daily.

Meloxicam, being the only new drug taken by the patient, was suspected as the causative agent and was therefore discontinued. Activated partial thromboplastin time (APTT) at presentation was 58 s (reference range, 22 s –38 s). A week after stopping meloxicam, it had fallen to 37 s. All other haematological parameters, including platelet count and international normalised ratio, were normal, as were renal and liver function. New bruises and haematomata stopped appearing 2 days after the patient stopped taking meloxicam. She continued taking clonidine and pantoprazole.

Meloxicam is a selective nonsteroidal anti-inflammatory drug (NSAID) (a cyclo-oxygenase 2 [COX-2] inhibitor). It was chosen for this patient in view of her reflux oesophagitis and because she had already been unresponsive clinically to one of the other COX-2 inhibitors. Unlike non-selective NSAIDs, meloxicam has been shown to have negligible effect on platelet function as measured by bleeding time.1-3 Rinder et al4 reported no prolongation of APTT or prothrombin time after 8 days of regular administration of meloxicam at 7.5 mg, 15 mg or 30 mg.

In spite of these contrary findings, I believe the prolongation of APTT and spontaneous bruising and haematomata in this patient were directly attributable to meloxicam, as the bruises disappeared 2–3 days after stopping the drug (with no other changes in the patient’s existing medication) and a repeat APTT a week after cessation of the drug was normal.