Are you on a blood thinner? If so, here are things you need to know
I ask this question to every patient coming in for surgery. Oftentimes, the patient’s reply is, “What counts as a blood thinner?” Or they mistakenly start to tell me about their blood pressure medicines ... So, what are we talking about?
Blood thinners reduce the body’s ability to form clots, although they don’t really change the viscosity of your blood. Blood clots are made up of red blood cells, white blood cells, platelets and a mesh-like material called fibrin. Clots can block arteries and veins anywhere in the body, causing heart attacks, strokes, difficulty breathing and swelling.
Blood thinners help prevent these devastating events in patients who have a history of or are prone to developing clots. Approximately 50 to 60 million Americans take one or more blood thinners. The majority, 47 million, take over-the-counter aspirin. More than 6 million take prescription antiplatelet agents that prevent platelets from sticking together. Eight million take anticoagulants that interfere with the signaling cascade of the clotting system.
If you take a blood thinner, here are three questions you need to know the answers to.
Which blood thinner(s) are you taking?
Antiplatelets
Aspirin is the most common antiplatelet. It blocks platelet activity and reduces inflammation that triggers platelet production. Low dose or “baby” aspirin (81 mg) works just as well as the normal dose (325 mg) for clot prevention. Clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brillinta), cangrelor (Kengreal), and vorapaxar (Zontivity) target platelets directly. Cilostazol (Pletal) and dipyridamole (Persantine), mainly used to improve peripheral circulation, also lower platelet function.
Anticoagulants
Warfarin (Coumadin) has been used as an anticoagulant since the 1950s. It competes with vitamin K, an essential ingredient for the body to make clotting factors. Because its effect is easily altered by how much vitamin K is in your diet, patients on warfarin need close monitoring with weekly to monthly blood draws.
Newer alternatives, Dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Lixiana), and betrixaban (Bevyxxa), work more directly and consistently on the clotting factors and don’t need periodic blood work. Heparin and its derivatives such as enoxaparin (Lovenox) must be injected into the vein or under the skin, but work well for people who only need anticoagulants for a short period of time.
Some herbal supplements, including ginseng, garlic, and ginkgo, have blood thinning properties and can exaggerate the effect of pharmaceutical blood thinners. So let your doctors know if you take any.
Why do you take it?
The most common reason for using an antiplatelet is coronary artery disease, especially if you’ve had a heart attack or received stents. Patients must take both aspirin and one of the stronger meds like clopidogrel for at least a month to a year after stenting, then continue daily aspirin indefinitely. A similar approach treats people who’ve suffered a stroke due to obstructed blood flow to the brain.
The most common reason for using an anticoagulant is atrial fibrillation (a-fib) – an abnormal heart rhythm. In a-fib, blood stagnates inside the heart, creating clots, which can flick off into the brain to cause strokes. A-fib is prevalent in older folks, affecting 4% of people by age 60 and 10% of those age 80+. Other conditions that require anticoagulation are: blood clots in the deep veins of the arms or legs, blood clots in the lungs, mechanical heart valve, and congestive heart failure.
When did you take it last?
Understandably, the main side effect of blood thinners is bleeding, ranging from bruised skin to unstoppable bleeding after trauma. Every blood thinner metabolizes at a different rate. Tell the emergency responders and doctors what you take and when you took it last so they can safely manage the bleeding event. Blood thinners also increase the risk of bleeding during surgery. Therefore, patients are told to stop the medicines for a certain number of days beforehand.
Eight blood thinners were approved in the last decade. More are coming. With the growing number of prescriptions and ever confusing drug names, it’s hard to keep track of what you take for what disease. If you’re unsure, ask your physician or pharmacist to review your med list and point out if it includes any blood thinner. Then add it to your medical alert bracelet or app.
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Qing Yang and Kevin Parker are a married couple and live in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. She is an anesthesiologist at HSHS Medical Group. Parker has helped formulate and administer public policy at various city and state governments around the country. He is formerly the group chief information officer for education with the Illinois Department of Innovation and Technology. This column is not intended to substitute for professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the views of their employers.
This article originally appeared on State Journal-Register: Are you on a blood thinner? If so, here are things you need to know
