Massage With Blood Thinners and Bleeding Disorders: Bruising and Bleeding Cautions

Urgent Signs First

Heavy or unusual bleeding is a medical problem, not a massage problem. The NHS lists these as signs of bleeding too easily on anticoagulants: blood in urine, blood in stools or black stools, severe bruising, prolonged nosebleeds, bleeding gums, vomiting blood or coughing up blood. [1] If any of these happen, contact your prescriber or urgent care promptly. In the US, call 911 for severe bleeding that does not stop.

Do not stop or change your blood thinner because of massage, or to "make massage safer". Only the clinician who prescribes it should change it.

Who This Page Covers

• Anticoagulants, often called blood thinners: the NHS names warfarin, rivaroxaban, dabigatran, apixaban, edoxaban and heparin, and notes that they do not actually make the blood thinner. [1]
• Antiplatelet medicines such as low-dose aspirin and clopidogrel, which the NHS describes as different from anticoagulants. [1] We found no massage-specific source on these, so the cautions below are about the same general bruising and bleeding concern.
• Bleeding disorders, in which the body lacks enough platelets or clotting factors, or they do not work as they should. They can be inherited, as hemophilia is, or caused by liver disease, lack of vitamin K, or medicines such as blood thinners. [2]

Why Bruising and Bleeding Matter

The main side effect of anticoagulants is that you can bleed too easily. [1] In hemophilia, the NHS lists easy bruising, long bleeding after injury, and joint pain, stiffness and swelling, and says people with severe hemophilia are at more risk of life-threatening bleeding. [3]

Massage presses and moves soft tissue, so a reasonable concern is that firm work could cause bleeding under the skin or deeper. That concern comes from how these conditions work, not from a trial of massage. Here is what the published reports show:

• NCCIH's reference list includes case reports titled "Large buttocks hematoma caused by deep tissue massage therapy" and "Acute spinal subdural hematoma after vigorous back massage". A hematoma is a pool of blood outside the blood vessels. [4]
• A 2013 case report described bleeding into the wall of the small intestine in a patient on warfarin after abdominal massage. [5]
• A 2019 case report described a spinal epidural hematoma (bleeding around the spinal cord) in a 20-year-old man three days after a Thai massage given by a friend; he had leg weakness and numbness and needed emergency surgery. The abstract does not say whether he used blood thinners or had a bleeding disorder. [6]

These are single cases. They show that serious bleeding after massage has been reported, not how often it happens or who is most at risk.

Steps That Sources Support

1. Tell your prescriber you are considering massage, and ask whether the type or pressure matters for you. This follows the general advice to discuss complementary therapies with your health care provider. [4]
2. Tell the therapist which medicine you take and why, and about any bleeding disorder. Ask for light, gentle work if your clinician agrees, and say at once if anything hurts.
3. Watch for warning signs afterward: large or spreading bruises, a hard painful swelling, new numbness or weakness, or any bleeding listed above. See massage bruising: what is normal and the warning signs checklist.
4. Ask before any firm style. NCCIH notes that rare serious cases involved vigorous types such as deep tissue massage. [4] See deep tissue massage risks and pressure limits.

Also read medication interactions, massage and blood clots (many people take blood thinners because of a past clot) and the safety overview.