30 March, 2024

All About Blood Thinners

Introduction:
Anticoagulants (blood thinners) are a group of medicines that decrease the human body’s ability to form blood clots. They don’t really ‘thin’ the blood, but the term ‘blood thinner’ is often used to help people understand.

The human body has an inherent capacity to form and destroy blood clots, and this process happens continuously and simultaneously to maintain a healthy blood flow and seal off any internal or external bleeding. This is the same process responsible for stopping bleeding after a skin cut. The problem occurs when the human body forms blood clots in undesirable situations. Take, for example, a patient who underwent open heart surgery and had his diseased native heart valve replaced by a metal valve (read more about heart valves here). A blood clot on a metal heart valve will directly interfere with its function and cause serious, even fatal, problems. Reducing the body’s ability to form blood clots is essential in such situations. Diseases like Pulmonary Embolism, Stroke, Deep Vein Thrombosis etc. require blood thinners to be prescribed for varied intensity and duration. It is obvious that if we reduce the body’s ability to form blood clots, the bleeding risk will increase.

Types of blood thinners:
Here is a list of commonly used anticoagulants or blood thinners (and common brand names in brackets). If your medicine’s ‘chemical composition’ has one of these names, you are taking blood thinners.
Warfarin (Coumadin, Warf)
Acenocoumarol or Nicoumalone (Acitrom)
Dabigatran (Pradaxa, Dabigo etc.)
Rivaroxaban (Xarelto, Rivaflo etc.)
Apixaban (Eliquis, Apigat etc.)

Certain anticoagulants are given in injectable form. They work the same, except that they are quicker in action, can be adjusted more rapidly to the body’s requirements, and can be stopped in case any bleeding complications arise. The commonly used injectable blood thinners are Unfractionated Heparin, Low Molecular Weight Heparin (Clexane, Fragmin), Bivalirudin (Angiomax), Fondaparinux, Argatroban, etc.

Please note that the brand names mentioned here are for representation only, and I don’t intend to endorse any particular product or brand. Many other brand-name drugs with similar drug compositions are available in the market. Please exercise caution while reading this list. Also, the pharmaceutical marketplace keeps adding new drugs, which may make this list incomplete.

Bleeding risk with blood thinners:
While blood thinners are crucial and life-saving, their nature of action adds additional risk for bleeding. Bleeding risk is minimized by following certain good practices:

  1. Routine follow-up with a healthcare provider for any dose adjustment that may be needed. This is particularly true for patients who take Warfarin or Acenocoumarol because dosing depends on INR (International Normalized Ratio) or Prothrombin Time (a blood test). Medicine doses for Warfarin and Acenocoumarol need constant adjustment since their actions differ for different individuals and they interact with almost everything we consume (food, medicines, etc.).
    *If you are on Warfarin or Acenocoumarol, discuss food habits that interfere less with the medicine with a dietitian. As a general rule, green leafy vegetables should be completely avoided or taken in a fixed amount daily.
  1. Don’t stop or re-start blood thinners unless instructed by your healthcare provider.
  2. It is routine to stop anticoagulants a few days before planned surgery. Please ask your doctor about it rather than stopping it yourself.
  3. If you are taking blood thinners and notice abnormal bleeding (for example, gum bleeding while brushing your teeth, bleeding from the nose, or new-onset reddish/bluish skin patches, etc.), promptly seek medical attention.
  4. Certain pain medication increases bleeding risk when taken along with blood thinners. Generally, pain medicines and blood thinners should be used with extreme caution.

A patient handout on blood thinners can be downloaded here.

Please note:
(1) There are a different class of medicines called “antiplatelet agents”, which are used in patients with blockages of the blood vessels (heart or others), particularly in those who had a stent or a bypass procedure done previously. These medicines are also called ‘blood thinners’. These medicines also reduce the body’s ability to form blood clots but are much weaker blood thinners compared to the drugs mentioned above. These medicines are: Aspirin, Clopidogrel, Ticagrelor, Prasugrel. They come under various brand names, which I will not mention here.

(2) Another class of medicines called “thrombolytics” are injectables and are only used in emergencies, like a heart attack or stroke (paralysis). They are super strong blood thinners, often called ‘clot busters’, and are always used under supervision. Because these drugs are very strong, the risk of bleeding is also very high.

I am sure I didn’t answer all your questions on this topic. Feel free to message me with your queries; I will happily answer them.

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