All about Blood Thinners

Everything you Need to Know about Blood Thinners

Blood thinners prevent the formation of blood clots and the associated life threatening conditions such as pulmonary embolism, heart attack or stroke.

Ασπιρίνη και τα Αντιπηκτικά

Blood thinners are prescribed either for conditions known to promote blood clots (e.g atrial fibrillation, mechanical heart valve, major surgery, stents, atherosclerosis) or after a clot has been formed (e.g. arterial or vein thrombosis and pulmonary embolism) to prevent new ones. When a clot has been formed, blood thinners will not dissolve it; however as they keep it from growing, they allow time to the body to release substances (thrombolytics) that will eventually break the clot down.

There are two types of blood thinners, the antiplatelets (e.g. aspirin) and the anticoagulants (e.g. heparin, warfarin), each one targeting one of the two different blood-clotting reactions in your body.

While their indications may differ, anticoagulants are considered more aggressive drugs than antiplatelets and carry a higher risk of serious side effects.

 

asp1Antiplatelets
Antiplatelets are a group of medicines (e.g. aspirin, clopidogrel, prasugrel, ticagrelor) that stop blood cells (called platelets) from sticking together and forming a blood clot.  While this is important to stop bleeding in case of an injury, it can be detrimental when occurring in vital blood vessels such the ones of the heart, the brain or the leg, leading to heart attack, stroke or foot gangrene respectively...

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Anticoagulants Anticoagulants
Anticoagulants are drugs (e.g. heparin, warfarin, dabigatran, rivaroxaban, apixaban, edoxaban) that interfere in the normal clotting process of your body lengthening the time needed to form a blood clot. In particular anticoagulants block one of the elements (proteins) of the clotting reaction...

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 Diet Guide for Warfarin (Coumadin) Users

How Do New Blood Thinner Pills Compare to Warfarin?
While warfarin (Coumadin) is the traditional well established anticoagulant, four new pills are currently available: apixaban (Eliquis), dabigatran (Pradaxa), Edoxaban (Savaysa), Rivaroxaban (Xarelto). Studies show that the latest drugs work as well as warfarin, however we do not have enough data to rank these ...

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Αντιθρομβωτικά και ΧειρουργείοBlood Thinners and Surgery
By thinning the blood, there is a higher risk for bleeding. During surgery this can be a problem. But that is only half the problem. The opposite is also true. If you stop blood thinners before surgery to prevent bleeding you can get a clot...

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How Do New Blood Thinner Pills Compare to Warfarin?

While warfarin (Coumadin) is the traditional well established anticoagulant, four new pills are currently available: apixaban (Eliquis), dabigatran (Pradaxa), Edoxaban (Savaysa), Rivaroxaban (Xarelto). Studies show that the latest drugs work as well as warfarin, however, we do not have enough data to rank these new pills from one to four. 

Diet Guide for Warfarin (Coumadin) Users

No matter which one you use, there will be still a risk of bleeding problems, but lower if compared to warfarin. They do have some conveniences over warfarin mainly the lack of frequent blood tests (INR) and dose readjusting. They also do not interfere with vitamin K so there are no dietary restrictions and they do not have as many drug interactions. Apart from being a well studied and established, Coumadin has one more advantage. If you get a dangerous bleeding problem, there is an established "antidote" that can reverse its blood thinning properties and control the bleeding. For the new blood thinners antidotes have been recently developed and their efficiency remains to be proven.

These new additions to the blood thinner family may have some benefits, but that doesn't mean you should drop your Coumadin prescription. If Coumadin has been working fine for you, without bleeding problems there is no compelling reason to switch. Warfarin is otherwise safer for patients with kidney failure or with a mechanical heart valve.

20 Tips for Blood Thinner Users

1. Stick to a schedule and take your medicine at the same time each day.

2. Do not double your dose if you missed one. Inform your doctor.

3. Be more careful to avoid injuries

4. Wear gloves when you use sharp objects

5. Wear shoes to protect your feet

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Blood Thinners and Surgery

By thinning the blood, there is a higher risk for bleeding. During surgery this can be a problem. But that is only half the problem. The opposite is also true. If you stop blood thinners before surgery to prevent bleeding you can get a clot.

Blood Thinners and Surgery

All kinds of blood thinners (antiplatelets or anticoagulants) can be a problem during surgery. Depending on your risk profile, the severity of the underlying condition you are receiving blood thinners for and the type of surgery you will undergo will guide your doctors’ decision towards one of the following solutions:

  • Stop the blood thinners before surgery and start them after surgery has passed. This option can be used if the surgery is high risk for bleeding and the need for a blood thinner is not very strong.
  • Change the blood thinner to a different kind for the time before and sometimes after surgery. Some blood thinners are cleared quickly by the body. Heparin is an example. This is a good solution for people who cannot stop blood thinners for too long. There are several kinds of alternatives. Some require injections and some require being in the hospital for intravenous treatment.
  • Changing the type of surgery. Some surgical procedures are riskier than others. Choosing a low risk procedure can make sense sometimes.
  • Not having surgery performed. This may sound harsh, but sometimes the risk for clots is so great that surgery needs to be reconsidered. Sometimes surgery is just postponed and sometimes it is cancelled altogether.
  • Have the surgery done without stopping the blood thinners. This is true for vascular and cardiac procedures where blood clotting is a major concern.
  • Placement of a vena cava filter. This is recommended for patients who are on blood thinners for a venous thrombosis or pulmonary embolism and will need to stop them for the surgical procedure. The Inferior vena cava is the large vein which is formed when the two large leg veins (iliac veins) merge in the pelvis. The vena cava transfers the blood back to the heart. The vena cava filter can catch blood clots that move from the leg veins to the lung.
vascular health

Vascular Surgeon

Dr. Efthymios (Makis) Avgerinos is a Vascular Surgeon, Associate Professor of Surgery in the Division of Vascular Surgery, University of Pittsburgh School of Medicine in USA.

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Scientific Editing

Efthymios D. Avgerinos, MD, PhD, FEBVS
Associate Professor of Surgery
Division of Vascular Surgery, University of Pittsburgh
Medical Center Pennsylvania, USA

E-mail: info@vascularhealth.gr