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Blood Thinners and How to Use Them Safely

Blood Thinners

What are Blood Thinners?

Blood thinner medications are prescribed for patients to help manage the flow of blood and prevent or minimize blood clots that can lead to serious medical problems. Approximately 2-3 million people take blood thinners, according to WebMD. They help to prevent disorders related to heart disease, blood vessel disease, lupus, and deep vein thrombosis (DVT). More specifically, blood thinners help overcome clotting problems related to:

Heart Disease

  • Certain heart or blood vessel diseases
  • An abnormal heart rhythm, atrial fibrillation
  • After heart valve replacement
  • A risk of blood clots after surgery
  • Congenital heart defects

Lupus

Approximately one-third of people with lupus have antibodies to molecules called phospholipids. Sometimes their antiphospholipid antibodies 

cause blood clots—called thromboses—that may lead to deep venous thrombosis, heart attack, or stroke. (2022)

Deep Vein Thrombosis

DVT is caused by a blood clot that forms in a major vein in a leg (rarely elsewhere). The clot may detach, and travel up and through the heart and into the lungs where it may get stuck. This causes inadequate blood flow, called a pulmonary embolism.  

Recently, doctors are prescribing blood thinners for some patients to deal with abnormal clotting associated with COVID-19. (2021) NIH)

Why Does Blood Clot?

The human body functions to stop bleeding by forming a blood clot where bleeding can occur, such as when we get a cut. If clotting didn’t occur, a wound—causing injury to a blood vessel—could ‘bleed out.’ Under normal conditions, platelets and proteins in the blood bonds and forms a clot at the site of the injury. Both veins and arteries can form clots. 

Under abnormal circumstances, blood clots occur unnecessarily, dislodge, and even travel into regions of the body where they can cause damage. To prevent such a scenario, blood thinning medication may be necessary.

Types of Blood Thinners

Blood thinners don’t make the blood thinner; rather, they prevent blood from clotting, sticking, or clumping. The two types of blood thinners, anticoagulants, and antiplatelets fall under the class, antithrombotic medicines, which, in simple terms means ‘not lumping’ or ‘not clotting.’

Blood is made up of plasma and platelets. Plasma contains water, proteins, and blood salts. Platelets are made up of red and white blood cells and platelets; platelets are the sticky-gooey part of blood you may notice when you’re bleeding. 

Blood-thinning anticoagulants prevent blood from clotting or clumping. Blood-thinning antiplatelets inhibit platelets from sticking/clumping against the walls of arteries, ultimately helping prevent platelets from closing blood vessels. Antithrombotic Therapy

The properties associated with antithrombotics are to prevent lumping, sticking, clotting, and clumping, enabling a naturally smoother flow of blood throughout the body.

Common Blood Thinning Medications

Anticoagulant medications that help prevent blood from clotting or clumping come in the form of pills or are injected. In some cases, anticoagulants are given as an intravenous infusion. 

Anticoagulant Medications 

  • Apixaban (Eliquis
  • Dabigatran (Pradaxa
  • Dalteparin (Fragmin) (injection)
  • Edoxaban (Savaysa) 
  • Enoxaparin (Lovenox) (injection)
  • Fondaparinux (Arixtra) (injection)
  • Heparin (Innohep) (injection)
  • Rivaroxaban (Xarelto
  • Warfarin (Coumadin, Jantoven) 

Antiplatelet medications that inhibit the platelets from sticking and clumping against the walls of arteries are most often taken orally.

The Most Common Antiplatelet

  • Aspirin

Aspirin is historically significant among antiplatelets. Acetylsalicylic acid in aspirin is synthetically extracted from salicylate and is commonly known to help prevent stroke and heart attack. The first antiplatelet medication marketed (after clinical trials and studies from the 1960s to the 1980s), aspirin established its efficacy as an anti-clotting agent. see: History of Aspirin

Antiplatelet Medications:

  • Cilostazol
  • Clopidogrel (Plavix)
  • Dipyridamole (Persantine)
  • Eptifibatide (Integrilin)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Tirofiban (Aggrastat)
  • Vorapaxar (Zontivity)

Medications source: Webmd

Some patients are prescribed antiplatelet medication in addition to aspirin. According to the American Heart Association, using this Dual Antiplatelet Therapy (DAPT) helps patients avoid another heart attack or stroke.

Natural Blood Thinning Sources

There’s a variety of ingredients found in nature believed to help reduce the risk of clotting. However, the substances haven’t been tested for purposes of comparison against prescription blood thinners. Therefore, natural remedies shouldn’t be taken with or instead of prescribed medication without first consulting your healthcare provider. Naturally occurring blood thinners include:

Turmeric

A spice from folk medicine, Turmeric gives curry dishes their distinctive yellow color. According to a 2012 study, its active ingredient, curcumin, acts as an anticoagulant. Turmeric inhibits coagulation cascade components, or clotting factors, that may prevent clots from forming. PubMed (2012)

Ginger

Ginger, in the same family as turmeric, contains salicylate (like aspirin), a natural chemical found in many plants. Other salicylate-rich foods include some berries, avocados, chilies, and cherries—all thought to keep blood from clotting. More studies could reveal whether these foods are as effective as prescription medicines.

Cinnamon*

Cinnamon (and cassia, a Chinese cinnamon) contain coumarin, found in certain drugs like Warfarin, that possess powerful anticoagulant properties.

Cinnamon and cassia may also lower blood pressure and relieve inflammation caused by arthritis and other inflammatory conditions. A systematic review (2015) suggests the health benefits of cinnamon as provided in this figure:

Source: ncbi

*Use caution when taking cinnamon as a blood thinner. A 2012 risk assessment demonstrated long-term cinnamon consumption in foods, including cinnamon-based bread and teas, can cause liver damage.

Other substances with evidence of blood-thinning properties include:

  • Cranberry
  • Dong Quai
  • Fenugreek
  • Feverfew
  • Garlic
  • Ginkgo
  • Red Clover
  • White willow
  • Cayenne peppers

Cayenne peppers possess high levels of salicylates and are ground up as a spice for food or taken in a capsule form. Cayenne peppers are also known to lower blood pressure and increase circulation. Source: Healthline 

Note: consult your healthcare provider before consuming foods and/or substances with blood-thinning properties.

Healthy Eating Choices

If you have cardiovascular (heart and blood vessel) disease, or you want to prevent cardiovascular disease, your healthcare provider may recommend a heart-healthy diet. 

The heart-healthy diet limits high-fat, high-cholesterol, and high-sugar foods, so it’s considered the best diet for overall health. A heart-healthy diet includes fresh fruits and vegetables, healthy proteins, whole grains, healthy oils, and low- or no-fat milk products.

If you take Coumadin (warfarin), it’s important not to eat more than small amounts of foods containing vitamin K. High vitamin K consumption may lessen the effectiveness of warfarin. Sources of vitamin K—often found in a heart-healthy diet—to avoid are: 

  • green leafy vegetables,
  • lettuce,
  • spinach, 
  • broccoli,
  • Brussels sprouts

Taking Blood Thinners Safely

Predictably, the main side effect of blood thinners is bleeding. Those taking blood thinners will notice that cuts and nicks take longer to stop bleeding, and skin bruises easily.

Note that serious bleeding, like bleeding in the gastrointestinal tract or brain, can occur, and can be life-threatening. Moreover, you might not even be aware of serious bleeding if you were to fall. Therefore, 

Call your doctor immediately if you have any of these signs of serious bleeding:

  • Menstrual bleeding that’s much heavier than normal
  • Red or brown urine
  • Bowel movements that are red or look like tar
  • Bleeding from the gums or nose that doesn’t stop quickly
  • Vomit that is brown or bright red
  • Anything colored red that you cough up
  • Severe pain, such as a headache or stomachache
  • Unusual bruising
  • A cut that doesn’t stop bleeding
  • A serious fall or bump on the head
  • Dizziness or weakness

All FDA-approved drugs list side effects; they may range from constipation and nausea to severe allergic reactions. Read and understand the side effects of all medications that you take.

It’s important to take blood thinners correctly. To help people stay safe when on a blood thinner regimen, think BEST, an acronym for:

Be Careful

Eat Right

Stick to a Routine

Test Regularly

from: AHRQ

Care in taking blood thinners comes down to: 

  • Taking your medication as/when directed.
  • No skipping or doubling up on doses.

If skipped, take the prescribed dose as soon as you remember; if you forget until the following day, call your healthcare provider.

  • Inspect medicines when you bring them home. 

Ensure your pills look as expected. Tell your other healthcare providers, including the dentist, about all medications you take. 

  • Patients on blood thinners need to be monitored. 

To begin, monitoring might occur every few days or every week. This ensures that a patient is taking an appropriate dose. Blood is monitored by drawing blood from a vein and sending the blood to an accredited laboratory to test, or it can be monitored by testing blood with a fingerstick using an INR test meter outside of a laboratory. Over time, frequent blood monitoring may be decreased.

Over-the-counter medicines may also interact with blood thinners. Consult your healthcare provider or pharmacist before using pain relievers, cold medicines, vitamins, herbal products, or stomach remedies. Even taking a tiny baby aspirin should be monitored.

It’s important to wear an emergency necklace or bracelet or carry a wallet card in case you need help. Download and print a wallet card here.

Warning!

Tell your doctor if you are pregnant or plan to get pregnant. Many blood thinners can cause birth defects or bleeding that may harm your unborn child.

Does Blood Thinning Medication Affect a Person’s Lifestyle?

You may need to avoid some activities and sports that could cause injury. While swimming and walking are safe activities, talk to your healthcare provider before starting new activities that could cause injury or leave you weary/fatigued.

High-impact sports should be avoided, but you can still do plenty of activities you enjoy. Though you shouldn’t be playing football, you needn’t sit on the sideline. Ask your healthcare provider about golf or other activities you may want to play; alternatives may be possible.

When working in the yard, for example, consider some protections such as wearing sturdy socks and shoes, and also wear gloves to protect the hands, and long shirt sleeves for arm protection. 

Ride your bike, but wear a helmet, or use a stationary bike. Limit using knives, razors, scissors, and similar sharp objects for obvious reasons. Generally, with the help and support of medication that possesses the power to save lives, people who take blood thinners can experience robust and meaningful lifestyles.

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