While necessary for certain patients, there are also concerns about blood thinners.
Information about Blood Thinners
Patients with heart disease or certain blood vessel disorders could be prescribed blood thinners to reduce the risk of clots, strokes, and heart attacks. Sometimes blood thinners are advised for patients about to have heart valve surgery, for those with heart defects that are congenital, and for some with atrial fibrillation (heart rhythm that is abnormal). The two types of blood thinners are anticoagulants (warfarin or Coumadin, heparin) and antiplatelet medications (aspirin).1 There are new medications on the market that are meant as an alternative to warfarin. Pradaxa and Eliquis were approved to help patients avoid getting a stroke from their atrial fibrillation. Xarelto was approved by FDA to do the same thing, it can also lower blood clot risk after knee and hip replacements, and it is approved for use in patients with deep vein thrombosis and pulmonary embolisms. Deep vein thrombosis is a condition in which blood clots occur in the thigh and lower leg. Pulmonary embolism refers to a clot that travels to block blood flow in the lungs. If patients are “doing well on warfarin, there is no reason to take a more expensive drug”. The dosing of warfarin, however, varies due to age, medications taken, and diet. Too high of a dosage leads to dangerous bleeding risks, while too little does not prevent the stroke risk. Patients must engage in regular blood tests and monitor the amount of vitamin K they consume. Vitamin K is found in greens such as chard, spinach, and kale. Patients need to “keep the level [of these vitamin-K rich foods] constant, and at a fairly moderate level” so that their dosage of warfarin can be most effective.2 Plavix is another medication available, and it “keeps the platelets in your blood from…clotting”.3
Concerns and Warnings
One advantage of the newer medications is that “constant surveillance (and)…dietary issues go away”. Pradaxa, Eliquis, and Xarelto also have “lesser likelihood of bleeding that could be troublesome”. Warfarin carries a serious side effect of “bleeding into the brain”. There is also a disadvantage to the newer medications, besides cost: “there is no ‘antidote’ as there is with warfarin”. This means that if there is too much warfarin in the blood, patients can be given vitamin K. Only fresh plasma can help with “overshooting” the new drugs. Fresh plasma also carries risk. It is also important to remember that if the new medications are at high levels and a patient needs emergency surgery, bleeding risk increases.4 While blood thinners can be life-saving medications for certain patients, there are risks about excessive bleeding and bruising. Any head trauma or falls can lead to life-threatening bleeding, such as into the stomach or brain. Less seriously, there is “nuisance bleeding” associated with blood thinners, such as from skin tears, nosebleeds, or shaving cuts. Patients need to take precautionary measures, such as wearing gloves to do yard work, wearing a helmet for cycling, taking care when shaving, wearing shoes, and using a soft toothbrush. For the nuisance bleeding, there are special products such as specific types of wound dressings and bandages.5