Joseph R. Anticaglia MD
Medical Advisory Board
Blood thinners, (anticoagulant or antiplatelet medications), are designed to treat blood clots that have formed, prevent the formation of new blood clots and stop blood clots from getting bigger.
Antiplatelet drugs, such as aspirin, prevent blood cells (platelets) from clumping together so they do not form blood clots. These drugs prevent platelets from sticking together and sticking to the walls of blood vessels. They’re usually prescribed to prevent future blood clots.
Anticoagulant drugs interfere with certain stages in the coagulation process. Both of these drugs have saved and extended the lives of many patients. However, there are risks attached to these blood thinners. Of special concern is the increased risk of serious bleeding problems in older patients.
Anticoagulants or blood thinners are used to treat patients with
- Atrial fibrillation
- those who have suffered a Stroke
- Pulmonary Embolism
- undergone Heart Valve , Hip or Knee surgery
- and persons with blood clots in the veins or arteries.
Pros and Cons of Certain Anticoagulants
Warfarin (Coumadin) was approved by the FDA, Food and Drug Administration in the 1950’s. It has proven to be a valuable and effective blood thinner for decades. Newer blood thinners are often compared to warfarin.
Pros
Warfarin is significantly less expensive than the newer blood thinners and it’s readily reversible in life threatening situations. If you experience uncontrolled bleeding while taking warfarin, it can be reversed by using vitamin K or fresh frozen plasma. If you miss a dose of this medication, it remains in your system for a day or two so that your still benefit from its anti-clotting action.
Cons
Dosage varies from person to person. It interacts with medications and with food rich in vitamin K (spinach, kale) making it less effective. It requires frequent blood (INR) testing to monitor dosing and effectiveness because of its unpredictability.
Xarelto and Eliquis are examples of newer types of anticoagulants called DOACs (Direct Oral Anticoagulants). You might be familiar with these medications because of seeing them advertised on television. Xarelto (Rivaroxaban) is taken once a day and Eliquis (Apixaban) twice daily.
Pros
Compared to warfarin, the above drugs do not require frequent blood clotting testing. The dose of the drugs doesn’t vary as much and are less susceptible to food and drug interactions. They have lower rates of severe bleeding events compared to coumadin. Andexxa (Adexanet alfa) reverses the unwanted, bleeding side effects of these blood thinners.
Cons
These drugs are costly compared to warfarin. The medicines leave the system quickly. If you miss a dose, it can increase your risk of serious bleeding problems. Laboratory testing of the kidneys is important with the above two DOACs medicines.
If you have been successful in controlling your problem with warfarin, there may be little
incentive to switch to a different medication. In general, tell your doctor about any new medications or supplements you are taking. If you plan to become pregnant, surely let the doctor know since blood thinners have been associated with birth defects.
Besides your doctor, your pharmacist is a good resource to answer questions about your medications. It’s useful to keep a list of medications you are taking in your wallet in case of an emergency. A greater number of anticoagulants are presently available and it’s worth the effort to work with your doctor to decide on the blood thinner that’s right for you.
References
- Fadi Shamoun et al; Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management; BioMed Research International. 2015
- 2019Sikorska Julia and Uprichard James; Direct Oral Anticoagulants: A Quick Guide; Eur Cardiol. 2017 Aug;
- Anticaglia, Joseph R; Atrial Fibrillation-AFib What is “Holiday Heart?” Doctor’s Column, 2019
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.