What You Need to Know About Blood Thinners

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, M.D., 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.

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/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.

Does starting a blood thinner make you nervous about increased bleeding risks? Are you wondering if you need to make adjustments in your life to avoid bleeding? A survey conducted by Wakefield Research and published by the National Blood Clot Alliance (NBCA), found that 55% of individuals on a blood thinner fear experiencing a life-threatening bleed.

Michael B. Streiff, M.D., chair of NBCA's Medical and Scientific Advisory Board reports, "The results of our survey demonstrate that people are making lifestyle decisions [and] possibly avoiding activities and hobbies they love – such as gardening or exercising – because they are afraid of experiencing serious or dangerous bleeding as a side effect of their blood thinning medication."

What is the best course of action if you are unsure about what precautions to take? Discuss this with your doctor. The survey results showed that 95% of people discuss risks and side effects of their medication with their provider. Your health care provider can help you determine if adjustments should be made or what precautions need be taken. Taking a blood thinner doesn't necessarily mean you need to lose your hobbies or have excessive fear, but it does mean you need to be informed and safe.

Streiff adds, "With this survey, our aim is to help people better understand and have confidence in the important treatment decisions that surround their care, and to stimulate important discussions with doctors, which we were particularly gratified to see are happening, because it is crucial that any unusual bruising or bleeding always be discussed with a doctor immediately. Make no mistake about it: Blood thinners save lives. But all medications have risks. What's important is to understand the risks, and to really understand how, or if, any of the activities you love could increase your risk for serious bleeding."

Christensen explains that in everyday life people do not typically need to stop their usual activities. If you enjoy gardening, wear gloves and a long-sleeved shirt to prevent cuts. If you have a family member that can use the power yard tools for you, ask them for assistance. Use caution in areas where you may get cut or bruised. There is more concern for severe bleeding risks associated with accidents, such as falls or major trauma. Taking a blood thinner does not require a complete shift in daily activities, but it does require assessing your situation and taking measures to protect yourself.

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."

Do you want to learn more? There are many places where you can access resources about blood clots, blood thinners and find a community. One of those is The National Blood Clot Alliance as previously mentioned. "NBCA is a voluntary health organization dedicated to advancing the prevention, early diagnosis and successful treatment of life-threatening blood clots such as deep vein thrombosis and pulmonary embolism," the website reads. Find insightful resources, education materials and volunteer opportunities as well as a "Test Your Knowledge" quiz for those taking anticoagulants associated with surgical procedures. Being proactive in asking questions and educating yourself is the first step to being safe while taking a blood thinner.

Blood thinners are very effective medications in the prevention of blood clots and aim to prevent serious conditions caused by blood clots. Always communicate with your provider to ensure proper treatment with these medications. Christensen stresses, "It is an important category of medications. They are very effective when used properly, and potential problems arise if they are not used strictly as intended."

Rachel Pugmire is a registered nurse, medical writer and mom. Her areas of expertise include emergency medicine, pharmaceutical clinical trials and pediatrics. She is passionate about utilizing her knowledge and experience to provide informative and meaningful content. Read More