All About Blood Thinners

Blood clots, referred to as venous thromboembolism (VTE) among medical professionals, are the leading cause of death in the U.S., yet they are preventable and treatable with blood thinners, according to the Centers for Disease Control and Prevention. Those who have experienced an injury to a vein, are experiencing slow blood flow, or have an increased amount of estrogen in their body are at higher risk for developing blood clots. Doctors prescribe blood thinners to help reduce this threat.

Blood Clot Formation

The body uses the complex system of hemostasis to form blood clots, during which the blood changes from a liquid to a more gel-like consistency. When a vessel receives damage, the blood moves outside of the vein and the body begins an innate process to stop the bleeding. First, the blood vessels constrict to reduce blood loss. Next, platelets begin to stick together to seal the break in the vessel by forming a platelet plug. Finally, clotting factors — inactive proteins found in the blood plasma — activate and form a fibrin mesh that traps some of the red and white blood cells. This results in a hardening of the platelet plug, which becomes a clot.

The Job of Blood Thinners

Sometimes, the blood creates too many clots. While a life-saving measure in some cases, blood clots are also a health risk because they prevent the blood from flowing freely through arteries and veins to specific areas of the body, especially the heart and brain. These clots can cause atrial fibrillation or a stroke. A physician may prescribe one of two types of blood thinners — an anticoagulant or an antiplatelet drug. Despite their name, blood thinners do not actually thin the blood or dissolve existing clots. Rather, they help slow the body’s ability to form new clots and can prevent any existing clots from increasing in size. Doctors check the level of the blood thinners in a patient’s body using a prothrombin time test, to ensure the amount is neither too high nor too low.

Anticoagulant Drugs

Doctors often prescribe anticoagulants for patients with a history of atrial fibrillation or abnormal heart rhythm, phlebitis, or congestive heart failure. This blood thinner option may also help individuals after a heart valve replacement or other surgical procedure. Anticoagulants block the clotting factors that help form the fibrin mesh that creates blood clots, therefore decreasing the chance of a clot. These drugs significantly reduce the risks of heart attacks, strokes, and blockages in the arteries or veins and come in oral and subcutaneous varieties.

Additional Indications for the Use of Anticoagulants

Doctors prescribe anticoagulants for patients for a number of reasons. According to a 2015 study from the National Institutes of Health, a growing number of people have congenital heart disease. For those born with a congenital heart defect, anticoagulants can prevent thrombotic events. Because anticoagulants slow down blood clotting, they prevent complications such as valve obstructions. A physician may also prescribe anticoagulants for those with deep vein thrombosis, pulmonary embolisms, or pulmonary hypertension.

Antiplatelet Drugs

Individuals with a history of heart attack or stroke may receive a prescription for antiplatelet medication. This type of blood thinner prevents the platelets from sticking together to form the platelet plug that results in blood clot formation. Doctors often combine two types of antiplatelet drugs, acetylsalicylic acid (ASA) and a P2Y12 inhibitor. They may also prescribe this drug therapy to prevent heart attacks and strokes in people at a higher risk for VTEs. In most cases, doctors administer antiplatelets orally.

Other Conditions that May Require Antiplatelets

People with coronary artery disease generally take antiplatelets for the rest of their lives. Additionally, doctors prescribe antiplatelets for patients who have had coronary artery bypass grafting. Physicians must sometimes surgically insert a stent into a patient’s clogged artery to keep it open and to prevent clots from blocking off the artery and causing a heart attack. Antiplatelets are part of the treatment process for these patients to help prevent more clots from forming.

Blood Thinners and Diabetes

Research indicates blood thinners are less effective for people with diabetes, and some anticoagulants can cause blood sugar levels to crash. However, both heart disease and strokes occur earlier and with higher frequency among diabetics. An Australian study showed that type 1 diabetes may trigger larger blood clots that can potentially cause these conditions. Physicians may prescribe very low levels of daily nonsteroidal anti-inflammatory drugs if they believe the patient has a high risk for cardiovascular disease.

Blood Thinners and Pregnancy

Women who are taking blood thinners should contact their doctor if they become pregnant and oral anticoagulants can cause congenital disabilities. However, dangerous blood clots can develop during pregnancy. Researchers say this is a natural reaction of the body, which is guarding the mother against major bleeding issues that may occur during miscarriage or childbirth. Women who have experienced blood clots in the past may require blood-thinning medications during pregnancy. Also, pregnant women with a family history of blood clots should notify their obstetrician of the issue.

The Dangers of Blood Thinners

For most people, the risks of taking blood thinners are lower than the potential complications of a blood clot. A person who has a stroke is much more likely to have a disability as a result of that stroke than a bad reaction to the medication. Although blood thinners can cause bleeding issues, they generally do not result in irreversible damage. Individuals taking blood thinners should not take vitamin or natural supplements without first discussing with their physician. Over-the-counter cold and allergy medications and pain relievers can cause the blood thinners to be more potent, creating bleeding risks. Antibiotics can cause a thickening of the blood, which lowers the effectiveness of blood thinners. Some doctors may advise patients who are taking blood thinners to avoid contact sports.

When to Seek Medical Attention

People on blood-thinner regimens should seek medical attention immediately if they begin to experience severe stomach pain, notice unusually heavy bruising, or see blood in their urine. Other symptoms that warrant emergency medical care include throwing up blood or a substance similar to coffee grounds. If the individual experiences tar-like stools, they should consult a physician. Before undergoing a medical or dental procedure, it is important to let the doctor know you are taking blood thinners.