Blood thinners

Primer on the New Blood-Thinning Medications

People whose bodies have a tendency to form dangerous and potentially life threatening blood clots may be put on blood-thinning or anti-clotting prescription medicines by their physicians in order to prevent these clots.

For years, the gold standard medicine for the prevention and treatment of blood clots was warfarin (often sold under the brand name Coumadin), an effective anticoagulant medication that makes your blood less likely to clot.

However, in recent years, new anti-clotting medicines have become available. Among these newer drugs are dabigatran (brand name: Pradaxa), rivaroxaban (brand name: Xarelto), apixaban (brand name: Eliquis), and edoxaban (brand names: Savaysa).

The newer medicines work as effectively as warfarin for most patients, but have some differences:

Patients taking warfarin need blood tests about once a week to once a month, to monitor blood thinning. Too thin or not thin enough detected by blood tests can be a problem and the dose needs to be regularly adjusted. Patients taking the newer medicines do not need regular blood tests to check how their blood is clotting, or changes in the dose.

Patients taking warfarin have to watch the amount of leafy greens and other vegetables (that contain vitamin K which affects warfarin effects) they eat. Patients taking the newer medicines have very few special rules about their diet. .

All anti-clotting medicines, including warfarin, can cause bleeding. Some kinds of bleeding such as bleeding in the brain – might actually be less likely with the newer medicines than with warfarin.

Some of the newer medicines do not have a good a way to reverse their effects. That means if someone has serious bleeding while taking one of these medicines, it can be hard for doctors to stop the bleeding. On the other hand, if a person starts bleeding while on warfarin, there are often ways to control it. Most new medications work for hours and the effects will pass over few hours. Hence the need for reversing the effects of any medications is rare and only for serious bleeding.

Warfarin usually costs significantly less than the newer anti-clotting medicines. The costs of regularly checking blood and adjusting medication doses must be considered into the financial equation when comparing medication prices.

People with a mechanical heart valve need to take an anti-clotting medicine. Currently warfarin is the only medicine indicated in these patients. People with mechanical heart valves should not take the newer anti-clotting medicines.

Some of the differences between the anti-clotting medicines are a matter of convenience, and the overall risk of serious bleeding is very low.

When do I need anticoagulant medicine?

The main reasons doctors prescribe anti-clotting medicines are to prevent blood clots or to treat blood clots that have already formed. These medicines do not dissolve clots, but they keep them from growing bigger and moving to another part of the body. The commonest reasons are new heart valves (typically metal or mechanical), prevent clot in conditions such as atrial fibrillation (irregular heart rhythm), deep vein thrombosis (clot in leg veins) or pulmonary embolism (clot in lungs) or those who have had hip or knee surgery where mobility may be affected for a while and increases the risk of clot in the legs and lungs.

If you need an anti-clotting medicine, your doctor might order blood tests to check how well your kidneys and liver work. If you have or develop kidney trouble, some of the newer anti-clotting medicines might not be right for you.

What information do I need when starting these medications?

If you take one of the newer medicines to prevent blood clots, there are certain things you should do. These are described below.

Know the strength (mg) and the reason for the medicine.

Take your medicine exactly as instructed.

Avoid other pain relievers or blood thinners like ibuprofen or aspirin, as these medications can also increase the risk of bleeding, especially in the stomach.

Notify your doctor before taking any new medicines. This includes prescription medicines, over-the-counter medicines, and herbal medicines. Certain medicines can change the effects of the newer anti-clotting medicines.

Wear a medical alert tag – Always wear a bracelet, necklace, or another kind of alert tag that warns people that you take an anti-clotting medicine and why. That way, if you are in an accident and are unable to explain your condition, responders will know how to care for you.

What are the side effects of the newer medicines to prevent blood clots?

The most common side effect is bleeding from any part of your body. The bleeding can be minor or sometimes serious. This even includes inside your body, where you cannot see it. Call your doctor right away if you took more medicine than you were supposed to or if you have any of these possible signs of bleeding:

Feeling sick to your stomach or throwing up blood or something that looks like coffee grounds

Nosebleeds or any bleeding that does not stop

Dark red or brown urine

Blood in your bowel movements or dark-colored bowel movements

Pain, swelling, or black and purple skin (bruising) after an injury

Unusual bleeding such as from your gums after brushing your teeth, heavy menstrual periods or bleeding between periods, are in a car accident, or have another type of serious injury especially to the head.

What can I do to lower the risk of bleeding?

Shave with an electric razor rather than a razor blade

Take care when using sharp objects, such as knives and scissors

Avoid doing things might make you likely to fall, such as walking on slippery surfaces or climbing on a high stool

Avoid sports that might cause injury

Always use a seatbelt

Avoid using non-prescription medicines that contain an ``NSAID`` (examples: ibuprofen or naproxen) unless you talk to your doctor first

Avoid consuming >2 drinks of alcohol, which can increase your risk of bleeding

If you see a new doctor, dentist, or nurse, let him or her know you are taking these medicines

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