Safety of Acupuncture in Patients Receiving Anticoagulant or Antiplatelet Therapy: An Updated Systematic Review of Bleeding-Related Adverse Events

Abstract

Acupuncture is used in patients with pain, neurological disorders, cancer-related symptoms, and other chronic conditions in which

anticoagulant or antiplatelet therapy is frequently prescribed. The practical concern is whether needling adds a clinically important

bleeding risk. This study was done to update and narratively synthesize the available clinical evidence on bleeding-related adverse

events following acupuncture in patients receiving anticoagulant or antiplatelet therapy.

Methods: PubMed/MEDLINE, PubMed Central, Europe PMC, the Directory of Open Access Journals, Google Scholar, Semantic

Scholar, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, publisher websites, and

citation lists were searched through 22 May 2026. Human primary reports were eligible when antithrombotic exposure, percutaneous

acupuncture, and a bleeding-related safety outcome could be verified. Because of substantial heterogeneity in study designs,

denominators, exposure definitions, and outcome measures, findings were synthesized narratively without meta-analysis.

Results: Nine reports were included: five observational reports and four case reports. Routine clinical studies generally reported no

bleeding or brief, self-limited microbleeding. In a prospective study, mild bleeding-related events were not more frequent in exposed

patients than in unexposed patients. A national Taiwanese analysis of 13,447,563 sessions found a modest association between

anticoagulants and minor bleeding, but no statistically significant association with major bleeding; antiplatelet therapy was not

significantly associated with post-acupuncture bleeding. Four case reports described clinically important intramuscular, intra

abdominal, or anatomically confined hematomas, some of which required surgical treatment.

Conclusion: Acupuncture appears to have a low risk of major bleeding in patients receiving antithrombotic therapy when appropriate

needle depth, anatomical site, and individual bleeding risk are considered.