More than 8 million Americans are prescribed blood thinners to treat or prevent blood clots — but many worry about bleeding risks
Starting a new medication — especially a blood thinner — can sound daunting. Are you feeling overwhelmed by this new medication and what you need to know?
Or have you been on a blood thinner for a long time and feeling like you need a knowledge refresh?
You aren’t alone. In the United States, more than 8 million people are prescribed blood thinners.
Shane Christensen, a family medicine physician, explains, “Blood thinners are used for the treatment of blood clots or the prevention of blood clots and their detrimental effects, such as strokes and pulmonary embolisms that can lead to death.”
They are most commonly used for the treatment of a deep vein thrombosis (a blood clot in a vein) and pulmonary embolisms (blood clot in the lungs).
“A deep vein thrombosis [DVT] most commonly occurs in the leg. We prescribe blood thinners to limit the damage and improve the recovery,” Christensen explains. Some other situations that may require a blood thinner are after surgery when mobility may be limited, after the placement of an artificial heart valve, or for those who have chronic atrial fibrillation.
“Choosing which medication to prescribe depends upon the patient’s situation, comorbidities, preference, cost and convenience for the patient,” Christensen says. In an outpatient setting the most common blood thinners are Warfarin, Xarelto and Eliquis.
Christensen explains that Warfarin is a customizable medication, which means the dose is adjusted to the patient. This requires patients to have regular monitoring through a blood test called an INR. Warfarin does have a higher risk of bleeding or bruising and is more sensitive to vitamin K in the diet because vitamin K increases clotting. Foods with the highest amounts of vitamin K include leafy greens like kale, spinach, collards or turnip greens.
Eliquis and Xarelto are a fixed dose and do not require blood monitoring, which many people find more convenient, but they can potentially be more expensive. Your health care provider can discuss with you which medication is best for you based on your diagnosis and situation.
Warning Signs
Blood thinners increase the risk of bleeding both externally and internally. Christensen explains, “The benefit of these medications is to prevent clots from forming, but you are more susceptible to bleeding and bruising. The most dangerous situation while on a blood thinner is a subdural hematoma from falling and hitting your head. If you are over anticoagulated — which is more likely to happen while on Warfarin — you can be at risk of having abdominal, intestinal or urinary tract bleeding.” You may notice that you bleed longer after getting cut because your blood takes longer to clot.
There are some signs of a subdural hematoma to watch for:
• Severe headaches or headaches that worsen
• Confusion
• Nausea or vomiting
• Seizures
• Altered speech
• Altered levels of consciousness or drowsiness
• Dizziness
• Loss of movement in certain areas of the body
• Signs of internal bleeding may include:
• Blood in your stools or black stools
• Red or brown urine
• Coughing up blood
It is crucial to seek medical attention if you experience these symptoms because internal bleeding can be a life-threatening condition.
Stick to a Schedule
When taking a blood thinner, it is crucial that you are educated and prepared to adhere to your medication treatment plan.
Christensen emphasizes the importance of sticking to your medication schedule.
“Since it is a critical treatment it is important to take them as directed. Try not to forget or skip a dose. You also don’t want to accidentally overdose. If there are memory problems that may cause you to take an extra dose or forget a dose, use a memory aide, a pill box or use assistance. Take your medications as directed. If you are unable to, come up with ways you can.”