Blood thinners: Are they right for you?

Jarred Sargeant, MD

Interventional Cardiology

Each year, between two and three million people in the United States take blood thinners, also known as anticoagulants or antiplatelets depending on their purpose. These medications are often prescribed when there is a high risk of blood clots or as part of recovery after a heart attack or stroke, but they are used to treat a variety of other medical conditions as well.

Interventional cardiologist Jarred Sargeant, MD, offered essential information on blood thinners, including how they work, what conditions blood thinners are prescribed for, and why aspirin isn’t effective and shouldn’t be used as a ‘replacement’ for blood thinners.

What conditions are blood thinners used to treat?

“Since blood thinners work to stop blood clots from forming within the body, you’ll mostly see them prescribed for vascular reasons, where we need to take action to help prevent blood clots or keep existing clots from getting any bigger,” said Dr. Sargeant.

Blood thinners are commonly prescribed for one of three major reasons, including:

• Atrial fibrillation: This condition, also known as AFib, causes an abnormal heartbeat and increases your risk of having a stroke.
• Heart valve replacement: People who receive mechanical heart valves, or heart valve replacements in general, are at an increased risk for blood clots that might travel and lodge in the valve, causing it to malfunction.
• Stent placement: When a stent is placed within an artery to open up blood flow, patients are often prescribed a variety of medications to prevent clots from forming around the stent.

What are the most common kinds of blood thinners?

The most commonly prescribed blood thinners are warfarin (Coumadin), aspirin, and clopidogrel (Plavix). Other blood thinners that might be used include Eliquis, Xarelto, Brilinta or Effient. Since each has differing levels of potential side effects and conditions they are best suited for, your cardiologist will assess which blood thinner is right for you when prescribing them.

Injectable blood thinners like Heparin or Lovenox are also sometimes used, but mostly in a hospital setting or during a specific procedure rather than prescribed for at-home use.

What are the potential side effects of blood thinners?

“With any medication, there’s always going to be some risk of adverse effects,” said Dr. Sargeant. “We commonly see patients noting that they bruise more easily or take longer to heal from cuts and scrapes due to the way the medication affects blood clotting after an injury. This is all expected, and your physician will warn you ahead of time about these effects.”

There are some more severe side effects possible, including gastrointestinal bleeding or bleeding in your stomach or intestines, bleeding in the brain which would require immediate emergency treatment, occasional dizziness and changes to urine or bowel movements.

Are there serious risks to taking blood thinners?

The main potential risk with blood thinners is an increased risk of severe bleeding. It’s a rare effect, but it’s important to stay alert and know what to look for so you can seek immediate care.

Can you just take aspirin instead of a prescribed blood thinner?

 “Aspirin is great, but it only works on one specific location at one specific part of coagulation, or the process of blood clotting,” said Dr. Sargeant. “Aspirin is specifically an antiplatelet. It does prevent some clot formation, but it doesn’t work the way warfarin and other blood thinners do and won’t prevent other kinds of clot formation.”

If you needed prescription blood thinners but chose to ‘replace’ them with aspirin, you would actually increase your risk of stroke or blood clots. It’s essential to take the specific prescription medication your cardiologist recommends.

Is there anyone who should not take blood thinners?

Anyone with a history of major bleeding events would be advised to be cautious when using blood thinners. However, in some cases the cardiologist may decide the benefits still outweigh the potential risks and will work with you to adjust medication to keep you safe.

If you start taking a blood thinner, will you have to take it forever?

“Honestly, the answer is that it depends on your unique medical condition,” said Dr. Sargeant. “Some people do need to take blood thinners for life, like in the case of AFib, recurring blood clots or if they have certain heart valve or other cardiac devices.”

In other cases, some patients might only need blood thinners for a limited time. People who receive heart stents, have had their first occurrence of blood clots, or have blood clots that resolve might not need to take blood thinners for very long.

Every person is different, and every situation is unique. Your doctor will work with you to find a solution that is right for you.