Blood thinners are sometimes a necessary risk

MIKE LEIFHEIT, Blanchard Valley Hospital’s clinical pharmacist coordinator, said doctors must always weigh the risks versus the benefits when prescribing blood thinners for patients. While the medications can save lives by preventing blood clots that could be fatal or cause a stroke, they also cause patients to bleed easily, meaning minor injuries can become major. (Photo provided)

MIKE LEIFHEIT, Blanchard Valley Hospital’s clinical pharmacist coordinator, said doctors must always weigh the risks versus the benefits when prescribing blood thinners for patients. While the medications can save lives by preventing blood clots that could be fatal or cause a stroke, they also cause patients to bleed easily, meaning minor injuries can become major. (Photo provided)

By SARA ARTHURS
Staff Writer
Many people take blood thinners and for a variety of reasons. The medication is commonly prescribed for ailments such as stroke and atrial fibrillation, a history of deep-vein thrombosis or a hereditary blood clotting condition. The medications have both benefits and risks.
In fact, blood thinners don’t make the blood thinner — they make it less likely to clot.
This can be a positive or a negative, according to Blanchard Valley Hospital’s clinical pharmacist coordinator Mike Leifheit. If a person is prone to blood clots, being on these medications can be a benefit. However, there is the risk of severe bleeding should the person become cut or bruised. So doctors must weigh the risks against the benefits.
Atrial fibrillation is a condition in which one chamber of the heart beats out of sync with another, which means the heart doesn’t work as well. Since the heart is not pumping efficiently, blood pools in the heart, which can lead to the formation of a clot that can travel to the brain and cause a stroke, Leifheit said.
Leifheit said a person’s blood includes several “factors” that are activated for either internal or external reasons. When the person cuts himself, a patch forms where platelets are caught, sort of like building a dam over a river, he said.
Trauma can trigger a clot. For example, if someone is in a car accident and doesn’t move for some time, blood can pool and cause a clot. Someone who has had hip or knee surgery can also be at risk.
The most common reason a person is prescribed a blood thinner is that they have had a stroke or a clot.
Leifheit said if someone has a blood clot in their leg, the medication can help prevent the clot from getting larger. One risk is a pulmonary embolism, or the clot traveling from the leg to the lung, which can be fatal.
There are several different blood thinning medications available and they all work a bit differently, Leifheit said.
“All of them prevent a clot from forming,” which means there is a risk of bleeding, he said. These medications can be prescribed to people of any age, including children who have hereditary conditions that affect how their blood clots, but are most commonly prescribed to seniors.
The oldest of the medications is coumadin, or warfarin. Leifheit said patients taking this need to have regular monitoring to determine how quickly their blood clots through an International Normalized Ratio, or INR, test.
Warfarin is “the cornerstone” and has been around for decades, he said.
“Most people know it as rat poison,” Leifheit said, because it is the same chemical but patients, unlike rats, are monitored to make sure they are on the correct dose. Leifheit said local farmers are familiar with the drug as a poison.
The INR test shows how long it takes the patient’s blood to clot, compared to a normal person’s blood. The target is to be two to three times a normal person’s. So where a normal person would score a 1 on this test, someone on warfarin might expect to score 2 or 3. If they score 4, it may be a sign they need to change their dosage, Leifheit said.
He said typically a patient must have this test every several weeks.
Other medications, unlike warfarin, do not require this regular monitoring. Leifheit said these medications are marketed to patients with this advantage and may be especially appealing to, say, someone in their 20s who may not want to have to be monitored every other month for the rest of their life.
However, the newer drugs have only been on the market for a few years and have their own disadvantages.
They work more quickly and leave a person’s system more quickly. Most need to be taken twice a day rather than once a day. And it’s harder to reverse the effects of these medications, meaning if a patient starts bleeding all that can be done is wait for the medication to work its way out of their system, Leifheit said.
“These agents aren’t for everyone,” he said.
Some of the medications have side effects, such as not working well for someone who has poor kidney function.
Patients must also pay attention to nutrition, specifically vitamin K, if taking warfarin. A patient eating lots of green leafy vegetables, which contain a lot of vitamin K, would need higher amounts of coumadin, so Leifheit said it’s important that patients be consistent with how much vitamin K they eat. He said the other medications do not have these dietary restrictions.
Being on one of these medications increases the risk that, if a patient were to start bleeding, he or she won’t be able to stop. Leifheit said someone who falls and hits their head, for example, could develop a bleed in the brain. So an older person who might be at a particular risk of failing might not want to be on one of these medications. Another example might be if someone is at risk of gastrointestinal bleeding.
An increased risk of bleeding can mean lifestyle changes. Leifheit knew one patient, for example, who had to stop doing mixed martial arts.
Arthurs: 419-427-8494 Send an E-mail to Sara Arthurs

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