- Living Your Best Life While Taking Blood Thinners
- Don’t Let Nuisance Bleeding Worry You
- How can I tell if I’m having a reaction to my blood thinner?
- Blood Clotting Effects
- Alarming Symptoms When Taking Blood Thinners
- Getting Help
- The Need-to-Know Side Effect of Blood Thinners
- How to Tell If the Bleeding Is an Emergency
- Two Ways to Reduce Blood Thinner Risks That Lead to GI Bleeding
Living Your Best Life While Taking Blood Thinners
Don’t Let Nuisance Bleeding Worry You
Each year, about 2 to 3 million people in the United States will need to take a blood thinning medication. The reasons for using blood thinning medications vary from person to person, but one thing is common to all people who take them: Blood thinners are a lifesaving medication, but bleeding risks must be effectively managed. Fortunately, there are ways to avoid and quickly stop superficial or nuisance bleeding.
Blood Thinner Medications Save Lives
Blood thinning medications come in two forms – a pill that is taken by mouth, or by an injection of the medication. Both types of blood thinning medications affect the body’s ability to make clots. Blood thinners can stop clots from forming, slow down the formation of clots, stop clots from getting bigger, or prevent clots that have already formed from travelling to other parts of the body.
Blood clots do play an important role in sealing up wounds when we cut ourselves or suffer other injuries, but when blood clots form in the blood stream, they can be very dangerous to a person’s health. The most common reasons for a healthcare provider to prescribe a blood thinning medication include:
- A person has an irregular heartbeat and is at risk for developing a clot that can cause stroke
- A person has a blood clot in their leg that can travel to the lung and prevent breathing
- A person has a blood clot in their lung that can prevent breathing
- A person had a serious injury or is having surgery, which can cause blood clots to form in the legs or lungs
- A person had a heart attack and is at risk to develop a clot in the heart that can travel to other parts of the body
- A person has a mechanical heart valve and is at risk to develop a clot in the heart that can travel to other parts of the body
COMMON RISK: BLEEDING
Blood thinning medications do save lives, because they can treat or prevent dangerous blood clots. But, they also pose one possible and very serious side effect: Bleeding. Since blood thinners slow the clotting of blood, unwanted and sometimes dangerous bleeding can occur with the use of these medications.
A person who takes blood thinners should tell their healthcare provider about any bleeding or unusual bruising they experience, as well as any serious falls or a hard bump to the head. Although infrequent, bleeding caused by blood thinners can be very serious or life-threatening, like bleeding into the brain or stomach. Serious or life-threatening bleeding requires immediate medical attention.
Most ofthe time though, bleeding caused by blood thinners is not serious orlife-threatening – like, for example, bleeding
after a skin tearfrom yard work. Bleeding like this is less serious, but can still be troublesome and inconvenient, and it can
seriously impactthe quality of a person’s day-to-day life.
- Frequent nosebleeds, or nosebleeds that last longer than five minutes
- A small cut while shaving with a razor might bleed longer than normal, or for more than five minutes
- A minor cut, laceration, or skin tear that may bleed for a long time
While this type of nuisance bleeding is not life-threatening, more than half of all emergency room visits among people who take blood thinners are for nosebleeds and other types of nuisance bleeding caused by superficial wounds to the skin. Most importantly, nuisance bleeding is also frequently to blame when people stop taking their blood thinning medication as directed by their healthcare provider, which puts them at risk again for the development of dangerous or life-threatening blood clots that can result in hospitalization and added healthcare costs.
HOW TO MANAGE NUISANCE BLEEDING
- People who take blood thinners can still engage in most of the activities thatthey enjoy. They just need to take some extra precautions and, for example:
- Be cautious about activities, such as high-risk sports, that may result in injury, and always wear proper safety gear, for example, a bike helmet when cycling
- Wear protective gloves when working with tools, such as gardening shears or other sharp instruments
- Be careful when trimming hair or nails
- Use a soft toothbrush
- Wear shoes to avoid cuts on feet
No matter how cautious a person might be, accidents can happen, and nuisance bleeding might still occur. When it does, there are several products, including special bandages, wound dressings, gels, and powders that can be used to help stop nuisance bleeding more quickly. Special bandages or wound dressings, like BloodStop® and the QuickClot® clotting sponge, are applied to superficial wounds to help control bleeding until medical attention can be provided, or to help stop bleeding more quickly. Also, there are products like Celex™ that form a protective gel cover over wounds to stop bleeding. There are also powders, like WoundSeal®,that can be poured onto the skin or site of superficial bleeding to quickly form an instant scab to stop bleeding in just a few seconds. WoundSeal can also be used with a special applicator to stop nose bleeds. Products like these are available without a prescription and can be found online or at most local pharmacies. They do not depend on or interfere with the blood’s natural clotting mechanism to be effective, so they can be used safely by people who are taking blood thinning medications.
Blood thinning medications save lives. People who take these medications can avoid or reduce bleeding risks by taking their blood thinning medication as directed by their doctor, and, when taking the oral blood thinning medication warfarin, by having their blood monitored regularly. People who take blood thinners should report any bleeding or unusual bruising to their healthcare provider. Some bleeding can be life-threatening and requires immediate medical attention. Some bleeding is superficial and not life-threatening, but can still be a nuisance. When nuisance bleeding does occur, over-the-counter products can help stop bleeding quickly and safely.
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How can I tell if I’m having a reaction to my blood thinner?
There are two main types of blood thinners: Anticoagulants, which work with chemical reactions in your body to slow down clot formations, and anti-platelet drugs, which prevent blood cells from clumping together to form a clot. The Mayo Clinic suggests that most heart attacks and strokes are caused by unusual clotting within the arteries. This clotting prevents necessary blood flow to the brain, while making the heart pump faster and harder until it gives out.
Anticoagulants are the medicines most commonly used to break up and prevent such clotting during strokes and heart attacks. Thrombolytic medicines, also called “clot busters,” are also used to dissolve blood clots that are blocking the coronary arteries.
Unfortunately, although these medicines are common and extremely good at preventing stroke and heart attack fatalities, if not handled correctly or properly monitored—they can cause serious bleeding issues.
Blood Clotting Effects
One of the many functions of your platelets and plasma, is to reduce excess bleeding by forming clots over injured tissues and blood vessels. Proteins within your plasma mix with your blood’s platelets and then solidify in order to keep your blood contained, instead of escaping through an injured area. However, blood thinners and anticoagulants are designed to halt this process in order to keep your arteries clear of clots.
Unfortunately, these medications can’t pick and choose which blood flow to control, or contain their effects solely to the blood within your arteries. This ultimately poses severely dangerous effects upon your entire bloodstream. If you’re wounded, sustain internal injuries, or if unknown bleeding occurs, you could be in serious trouble. Instead of your body reacting to stop the bleed, it will allow the flow to continue, possibly leading to excessive blood loss.
Alarming Symptoms When Taking Blood Thinners
When taking blood thinners or anticoagulants, make sure you stay alert and keep a watchful eye out for these symptoms of internal bleeding problems:
- Black or tarry-appearing stools. Dark stools can be an indication that blood is present. This could mean that your intestines or stomach are pooling with blood.
- Orange, pink, or smoke-colored urine. Discolored urine could be a sign of bleeding in the kidneys or bladder.
- Abnormal and sometimes profuse bleeding. Since blood thinners are meant to prevent clotting, they also affect how the blood clots outside the body. This could result in even small cuts bleeding for long periods of time—putting you at risk of losing too much blood.
- Excessive bruising. Since bruises are basically broken blood vessels underneath the skin, excessive bruising can be an indication that your blood thinners are causing your blood vessels to leak and swell.
- Blood shot eyes. Your eyes have hundreds of tiny blood vessels that can become swollen or irritated by thinned blood. These vessels can also pop with increased blood pressure and be an indication of swelling or bleeding in the brain.
- Stomach pain. Bleeding within your stomach lining due to ulcers, polyps, or irritations can cause extreme nausea and cramping.
- Muscle aches. When your muscles don’t receive enough oxygen from fast moving and sometimes decreased blood flow, the tissues start to break down causing aches and pains.
- Intense headaches. Swelling, bruising, and bleeding in the brain can cause intense pressure headaches.
- Dizziness. The decreased amount of oxygen as a result of blood pooling in other areas of the body, can cause hypoxic effects on your brain and muscles, making you feel dizzy and weak.
If you experience any of the above symptoms after starting a new blood thinning medication, seek medical attention immediately. Your body needs your blood in the right places at the right times in order to function properly. You have the right to make sure you’re in good health, especially if you’re at risk for a heart attack or stroke. You also have the right to know your risks before taking new medication, and to fight back when your prescribed medication causes you harm.
For more information about your prescription rights, contact us today for a free consultation, or like us on Facebook for periodic updates.
The Need-to-Know Side Effect of Blood Thinners
1. Follow your treatment plan to a T. Be sure you’re taking your medication exactly as directed by your doctor. If you don’t take enough of the blood thinner, it might not be able to prevent a clot. But if you take too much, it can increase your risk for bleeding even further, according to the American Heart Association (AHA). Typically, the AHA recommends that people on blood thinners should have their blood monitored on a monthly basis.
2. Avoid taking drugs that can increase your risk of heavy bleeding. That includes non-steroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin (ibuprofen), and Aleve (naproxen), says Marcelo Gomes, MD, associate staff member in the section of vascular medicine at the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Sydell and Arnold Miller Family Heart & Vascular Institute of the Cleveland Clinic in Ohio. Some supplements also can increase your risk of bleeding, says Dr. Gomes. St. John’s wort is one; there’s also some concern that high doses of omega-3 supplements can make blood thinners more potent, according to the Cleveland Clinic. If you haven’t done so already, tell your doctor about every dietary supplement you are currently using and consult with him or her before taking any new ones — even if those products are labeled as “safe” or “all natural.”
3. Pay extra attention to your diet. If you’re taking blood thinners, you shouldn’t make any major dietary changes without talking to your doctor first. You’ll also want to avoid eating too much vitamin K, which is found in foods such as asparagus, broccoli, and leafy greens like kale. (The vitamin encourages blood clotting and can interfere with the actions of certain blood thinners like warfarin, according to the U.S. National Library of Medicine.) You should also steer clear of cranberries and alcohol, which can enhance the effects of blood thinners and further increase your risk for bleeding, says Dr. Gomes.
RELATED: The Best Diet to Prevent a Stroke
4. Avoid taking any physical risks. This isn’t the time to organize a rugby league. “Generally, patients should avoid any activity that may result in frequent or potentially serious trauma, such as skiing and contact sports,” says Gomes. “No bungee jumping or sky diving.” And even when you’re participating in low-risk sports, you should always wear proper safety gear, like a helmet and gloves.
5. Be more cautious in general. It’s smart to avoid any abrasive or sharp objects, according to the National Blood Clot Alliance (NBCA). For example, choose soft-bristle toothbrushes and shoes that don’t hurt your feet. And be careful when you’re using razors, scissors, and your favorite paring knife.
6. Don’t wait to seek help. If you do fall or sustain an injury, especially a blow to the head, don’t hesitate to go to the doctor’s office or even the emergency room if necessary, says Dr. Haut.
How to Tell If the Bleeding Is an Emergency
When you’re taking a blood thinner, says Gomes, you may bruise more easily and may also notice bleeding around your gums after brushing your teeth. In most cases, bleeding caused by blood thinners is not serious, according to the NBCA. If you get a minor cut while working in the yard or the kitchen, the bleeding might last longer than usual. You could also experience frequent nosebleeds that last for several minutes. Though frustrating and inconvenient, these occurrences aren’t life-threatening.
However, blood thinners can cause dangerous bleeding that requires immediate medical attention, says Gomes. Major bleeding complications include internal bleeding in the stomach, bowel, or brain, he says. “This could be life-threatening,” he adds. “Intracranial hemorrhage is the most feared complication.” And, Haut notes, the damage caused by bleeding in the brain may be irreversible.
So, in addition totaking steps to prevent bleeding, it’s also important to recognize the warning signs of this potentially serious side effect:
- Excessive menstrual bleeding
- Coughing up anything red in color
- Severe headache or stomachache
- Dizziness or weakness
- Blood in the urine or bowel movements
Two Ways to Reduce Blood Thinner Risks That Lead to GI Bleeding
For some patients on blood thinners, gastrointestinal bleeding caused by those medications is an adverse event that can be disabling or even fatal.
New research highlights two strategies to potentially reduce the risk.
Some patients are simply taking too many blood-thinning drugs that increase their bleeding risk, while others could start another medication to reduce the risk of gastrointestinal bleeding, Michigan Medicine investigators say.
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And those takeaways build on previous research that shows the use of just one low-dose anticoagulant already nearly doubles the risk of upper gastrointestinal bleeding.
“Anticoagulation strategy is all about the balance between preventing blood clots and reducing the risk of bleeding complications,” says senior author Geoffrey Barnes, M.D., M.Sc., a vascular cardiologist at the University of Michigan Frankel Cardiovascular Center and an assistant professor of internal medicine at the U-M Medical School.
SEE ALSO: More Than One-Third of Patients Risk Major Bleeding By Doubling Up on Blood Thinners
Barnes and other researchers studied 6,907 patients who started using the popular anticoagulant warfarin (also known as Coumadin or Jantoven), between 2011 and 2018, and went to a clinic as part of the Michigan Anticoagulation Quality Improvement Initiative — a multicenter quality improvement collaborative of anticoagulation clinics across the state sponsored by Blue Cross Blue Shield of Michigan.
Nearly half faced an avoidable danger: Forty-five percent of the patients on warfarin were also using anti-platelet therapy such as aspirin, which increases the risk of bleeding.
“Overall, 36 percent of the patients in our study could benefit from one or both of the strategies we present to reduce the risk of GI bleeding,” Barnes says.
The research was published in Vascular Medicine.
Doubling up on blood thinners
Patients in this study were most likely to take blood thinners for venous thromboembolism, which is a blood clot in a vein, or to prevent a stroke due to existing atrial fibrillation.
But the use of two blood antithrombotics might be increasing some patients’ risks of GI hemorrhage without further reducing their risk of having a stroke, researchers say.
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“Many patients may not need to take a medication like aspirin if they’re already taking warfarin,” Barnes says. “We couldn’t find a reason for the second anticoagulant for about 30 percent of the high-risk patients who were on multiple blood thinners. These patients may be able to reduce their risk of GI bleeding simply by stopping one of their blood thinners.”
Some appropriate indications for adding anti-platelet therapy to prevent blood clots in patients already taking warfarin, researchers say, include a recent history of coronary artery disease or heart attack, peripheral arterial disease, coronary artery stents, bypass surgery, stroke or mini-stroke (TIA), or an autoimmune disorder called anti-phospholipid antibody syndrome.
What about patients that actually do need to take multiple blood thinners, such as warfarin and clopidogrel?
Researchers cite a decade-old expert consensus that recommends something just a minority of clinicians are doing: adding a proton pump inhibitor such as omeprazole (also known as Prilosec) to help suppress acid production in the stomach.
“For those who remain on warfarin plus an antiplatelet drug, a PPI is appropriate to reduce the risk of gastrointestinal bleeding,” says first author Jacob Kurlander, M.D., M.Sc., a gastroenterologist at Michigan Medicine and clinical lecturer in internal medicine at the U-M Medical School. “We know PPIs can reduce the risk for ulcers by around 80 percent.”
Yet in the Vascular Medicine study, only about one in three patients at high risk for GI bleeding were treated with Prilosec or another PPI.
“We’re failing to take advantage of a very effective medication that can prevent a morbid event for people with ulcer risk factors,” Kurlander says, adding that apprehension about PPIs may be partially to blame — and that not everyone should be prescribed a PPI.
Multiple Adverse Effects
PPIs have been linked with multiple adverse effects, including bone fractures and kidney disease, but research hasn’t yet shown whether they’re at fault or simply linked in a noncausal way, he says.
“The theoretical risks of PPIs need to be weighed against the real risk of bleeding,” says Kurlander, who also cares for patients at the VA Ann Arbor Health Care System. “In patients at high risk for bleeding, like those on warfarin and aspirin, the benefits of PPIs for prevention generally outweigh the risks. Bleeding is a common cause of GI hospitalization that is often quite predictable beforehand.”
Providers may not follow the 2008 expert consensus on PPIs because they don’t know about it, because it wasn’t an official guideline statement or because they’re waiting on newer, high quality studies, Barnes says.
Some recent and ongoing studies are currently trying to address the specific question of whether prescribing a PPI reduces the risk of bleeding in those patients on multiple blood thinners, he adds.
In the meantime, Barnes and Kurlander say anticoagulation clinics, which provided the data for this study, might be the right place to examine the underuse of PPIs among patients who take blood thinners.
“Identifying these patients can be a challenge, which could be a great opportunity for anticoagulation clinics to play a role,” Barnes says. “They know when patients are on one or multiple blood thinners.”
The anticoagulation clinics, he says, might be able to identify patients who could be candidates to reduce the number of blood thinner medications or prescribe PPIs, and then reach out to the prescribing doctors to see if one of those actions is appropriate.
“Future studies should look at the feasibility of the anticoagulation clinic to identify patients at high risk for GI bleeding and recommending medication changes that could reduce the risk of bleeding,” Barnes says. His research team is currently testing this within the Michigan Anticoagulation Quality Improvement Initiative.
Another new study out of Michigan Medicine found a significant increase in adverse outcomes for people taking both aspirin and warfarin, without a difference in stroke or heart attack outcomes. That paper, led by Barnes and Jordan Schaefer, M.D., a hematologist at Michigan Medicine and assistant professor of internal medicine, was published in JAMA Internal Medicine.
Barnes and Kurlander are both members of U-M’s Institute for Healthcare Policy & Innovation.
Disclosure: Barnes has received grant support from Pfizer/Bristol-Myers Squibb, NHLBI, and Blue Cross Blue Shield of Michigan. He also has received consulting fees from Pfizer/Bristol-Myers Squibb, Janssen, and Portola.
TUESDAY, Oct. 3, 2017 (HealthDay News) — Blood-thinning drugs can save your life by preventing a heart attack or stroke caused by artery-blocking blood clots.
But these are powerful drugs, and a pair of new studies detail side effects people need to understand before taking them.
The effectiveness of a class of blood thinners called nonvitamin K oral anticoagulants (NOACs) can be significantly altered through interaction with other drugs, the first study reveals.
In some cases, these drug interactions increase a person’s risk of life-threatening bleeding in locations such as the brain and gastrointestinal tract. In other cases, the NOACs’ effectiveness is reduced, robbing patients of some protection against stroke and heart attack.
“NOACs alone do not pose a significant risk of bleeding, but the concurrent use of NOACs with certain drugs that share the same metabolic pathways may cause increased risk of major bleeding,” said study lead researcher Dr. Shang-Hung Chang, an associate professor of cardiology with Chang Gung Memorial Hospital in Taoyuan, Taiwan.
Meanwhile, a second study found that blood thinners can greatly increase a person’s risk of finding blood in their urine.
As a result, patients might unnecessarily wind up in the hospital or emergency room, or undergo an unneeded invasive procedure, said senior researcher Dr. Robert Nam. He is a professor of surgery and head of genitourinary oncology with Sunnybrook Health Sciences Center in Toronto.
“Patients and physicians need to discuss this, to try and prevent patients having to be hospitalized or come to the emergency room in the middle of the night,” Nam said.
The first study looked at the bleeding risk associated with NOAC drugs dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis).
These drugs are primarily used to prevent risk of stroke in people with atrial fibrillation, an abnormal heart rhythm that can cause blood to pool and clot inside the heart, said Dr. Deepak Bhatt. A spokesman for the American Heart Association, he is also executive director of interventional cardiovascular programs at Brigham and Women’s Hospital’s Heart & Vascular Center in Boston.
NOACs are being used more frequently because they’re easier to use and produce fewer side effects than warfarin, an older anticoagulant that has many food and drug interactions, said Bhatt.
Chang and his colleagues also decided to investigate whether NOACs might have previously unknown interactions with other commonly used medications. The team analyzed health data on 91,330 Taiwanese patients with atrial fibrillation who were prescribed an NOAC.
The investigators found that bleeding risk increased significantly when NOACs were used in combination with amiodarone, fluconazole, rifampin and phenytoin — four drugs that treat widely different conditions.
The researchers also found that other drugs dampened the effectiveness of NOACs, including atorvastatin, digoxin, and erythromycin or clarithromycin.
Bhatt said he’s particularly concerned about the effect of atorvastatin (Lipitor) on NOACs’ effectiveness.
“That’s a very commonly prescribed cholesterol-lowering drug, especially now that it’s generic,” Bhatt said. In fact, the researchers found that atorvastatin was the drug most commonly prescribed alongside an NOAC.
“That’s a big deal because that means all those patients on both drugs have a lower risk of bleeding, but on the flip side then would have a higher risk of stroke,” Bhatt said.
The second study found that people are much more likely to go to the hospital for blood in their urine if they’re taking blood thinners.
Nam and his colleagues examined medical data on 2.5 million Ontario residents, including nearly 809,000 who had been prescribed a blood thinner.
During an average follow-up period of 7 years, people on blood thinners were six to 10 times more likely to wind up hospitalized or in the ER complaining of blood in their urine compared with others not taking the drugs, Nam said.
Although blood in urine is alarming and requires investigation, Nam said the side effect is not immediately dangerous. Patients should be informed of the potential for blood in the urine, and counseled what to do if it occurs.
“The result of these findings should not affect the decision to treat with these drugs,” Nam said. “The benefits outweigh the risks. These are not life-threatening complications. Patients should not stop taking these drugs because of the potential side effect.”
In at least one way, this side effect can be welcome, said Dr. Vincent Bufalino, an AHA spokesman and cardiologist in Naperville, Ill.
“Blood thinners can be an advantage because when they cause bleeding in someone on a normal dose, usually there’s a medical issue,” Bufalino said. “It actually helps you uncover a problem.”
The researchers found that rates of bladder cancer detection were twice as high in people taking blood thinners compared to the general population. The drugs made the tumor produce more blood, Nam said.
“Because it bled, they went in, looked, and found the bladder cancer and were able to get it earlier than would have happened waiting for a patient to develop symptoms on their own,” Bufalino said. “In many of these circumstances, the cancers would have been missed until they were more advanced because the patient wouldn’t have known there was a problem.”
The two studies were published in the Oct. 3 issue of the Journal of the American Medical Association.
To learn more about blood thinners, visit the American Heart Association.