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What to know about blood thinners for heart disease

Blood thinners help prevent and treat blood clots. Blood clots can partially or completely block blood flow through a blood vessel.Doctors refer to blood clots as thromboses. A blood clot can cause serious health effects, such as a heart attack, stroke, or pulmonary embolism.In this article, learn about blood thinners for different types of heart disease and how they prevent and treat blood clots. We also discuss the side effects and risks of taking blood thinners.
a hand holding two blood thinners pillsShare on PinterestThe most suitable type of blood thinner may depend on a person's medical history.People take blood thinners to prevent the formation of blood clots and reduce their risk of heart attack, stroke, and pulmonary embolism.Blood clots can cause different types of heart disease. People can also develop heart disease if they have atherosclerosis, which is a buildup of fatty deposits in the arteries.Blood clots can partially or completely block a blood vessel. They can form anywhere in the body but are more common in certain areas. The area where they develop will determine the severity of the risk that they pose.If a person has a blood clot in the blood vessels leading to the brain, they can have a stroke, while a blood clot in the blood vessels around the heart can result in a heart attack. People with atrial fibrillation are also at risk of stroke due to blood clots developing in the heart.Doctors use the term pulmonary embolism to refer to a blood clot in a major blood vessel in the lungs. They call a blood clot in the legs a deep vein thrombosis (DVT). A DVT can dislodge and move up to the lungs, causing a pulmonary embolism.Blood thinners act on different parts of the clotting pathway that can lead to blood clots. Doctors use specific blood thinners that block factors that cause blood clots.People with clots in their arteries due to a platelet plug — the stage before a thrombosis forms — may require a different type of blood thinner that acts on particular blood cells, such as platelets.Below, we cover the different types of blood thinners for heart disease.
Today, doctors can choose from many different blood thinners. They will select the most appropriate blood thinner depending on their evaluation of the person, which is likely to take into account:the person's family and personal medical historytheir risk factors for developing blood clotsthe location of the blood clotwhether it is the person's first blood clotthe severity of the blockageThere are two categories of blood thinners: antiplatelets and anticoagulants.AntiplateletsA person may receive injectable, intravenous, or oral antiplatelet medications. Antiplatelet medications that people take orally include:aspirinclopidogrel (Plavix)ticagrelor (Brilinta)prasugrel (Effient)pentoxifylline (Trental)cilostazol (Pletal)dipyridamole (Persantine)The injectable or intravenous antiplatelet drugs include:tirofiban (Aggrastat)eptifibatide (Integrilin)AnticoagulantsIn some situations, doctors will prescribe anticoagulants. There are three classes of anticoagulants:heparin and low molecular weight heparinvitamin K antagonists, such as warfarinnewer direct oral anticoagulantsThe following table lists the drugs in these categories.Vitamin K antagonistsNewer direct oral anticoagulantsHeparinswarfarin (Coumadin)dabigatran (Pradaxa)heparinedoxaban (Savaysa)enoxaparin (Lovenox)rivaroxaban (Xarelto)dalteparin (Fragmin)apixaban (Eliquis)Blood clotting is a complex process that depends on many factors. Warfarin works by preventing vitamin K-dependent clotting factors from forming.Newer direct oral anticoagulants inhibit other factors, such as factor Xa or an enzyme called thrombin, both in the blood and in existing clots.Heparins also inactivate thrombin, which helps treat clots and prevent new ones from forming.
People who take blood thinners are at an increased risk of excessive bleeding. If they cut themselves, it may take longer for the bleeding to stop. Sometimes, bleeding may require medical attention.The most common side effects of antiplatelet medications include:easy bruisingnosebleedsblood in the urinehemorrhage or large bleedsbleeding in the stomachbreathing difficulty due to ticagrelorlow blood platelet countaspirin-induced asthmanasal polypsWarfarin can also cause bleeding, which can occasionally be severe. Some people can experience major bleeds in the brain, eyes, and digestive tract.Other side effects of warfarin include:nauseavomitingstomach painbloatingflatulence (gas)change in the sense of tasteIf a person experiences dangerous bleeding from warfarin, doctors can reverse the drug's action by giving them intravenous vitamin K and fresh frozen plasma or prothrombin complex concentrate.Newer direct oral anticoagulants have an association with lower rates of major bleeds, including life threatening bleeding and bleeding into the brain.The newer direct oral anticoagulants also have commercially available medicines to reverse their actions.If people experience heavy bleeding or hemorrhage, doctors will stop giving them the drug and provide protamine sulfate, which inactivates heparin.Other side effects that may occur when using heparin are:low blood platelet countosteoporosisfractureslow levels of aldosterone, a hormone that regulates salt and water in the bodyallergic reactionsPeople taking blood thinners should let their doctors know about any other medications that they are taking. Some blood thinners also interact with certain foods.In general, combining blood thinners with other drugs that cause bleeding further increases a person's risk of bleeding.Antiplatelet medicationsOther substances that may interact with aspirin or antiplatelet medications include:diureticsnonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil)steroid drugsalcoholAs well as interacting with other drugs that thin the blood, Plavix and Effient may interact with opioids. Plavix also interacts with omeprazole (Prilosec), which reduces stomach acid.Brilinta can interact with digoxin (Lanoxin) and with high doses of simvastatin (Zocor) and lovastatin (Altoprev).A doctor will closely monitor people who take blood thinners.WarfarinDoctors who prescribe warfarin must warn the person about the many drug and food interactions that occur with this anticoagulant.Some substances that interact with warfarin include:antibioticsantifungalsbotanical or herbal productsother anticoagulants and antiplatelet agentsfoods containing vitamin KPeople need to do frequent blood tests when taking warfarin. Doctors will use the blood test to check a person's International Normalized Ratio (INR).The INR test provides important information to help doctors determine the appropriate dosage of warfarin. Drug and food interactions can cause changes in a person's INR.An INR reading that is too low puts people at risk of clotting, whereas a reading that is too high indicates an increased risk of bleeding. The correct reading for someone on anticoagulants is 2–3.Doctors may also tell people taking warfarin to pay attention to the vitamin K content in the foods that they eat. People taking warfarin should not avoid vitamin K altogether, but they may need to limit their intake of it.Learn more about vitamin K, diet, and warfarin in this article.HeparinAnyone who takes heparin or low molecular weight heparin should avoid any drugs that increase the risk of major bleeding.If someone requires other blood thinners while taking heparin, doctors will need to monitor the person closely for signs of bleeding.Newer direct oral anticoagulantsCompared with warfarin, newer direct oral anticoagulants have fewer drug interactions and may be safer options, although more, long-term clinical use is necessary to confirm this.These drugs also do not require people to make dietary changes or have INR monitoring. Researchers note, however, that newer direct oral anticoagulants may be more expensive than warfarin for many people.Some foods and supplements have blood-thinning effects. People who need to take prescription blood-thinning medications should limit or avoid these foods and supplements, which may increase their risk of bleeding.The following supplements and foods may thin the blood:Blood thinners include antiplatelet and anticoagulant medications. People who have a blood clot or a higher risk of developing one may need to take one or more blood thinners to prevent problems, which can include:a heart attacka strokepulmonary embolismDoctors and pharmacists must explain the risks of taking blood thinners, including the possible drug and food interactions, to prevent excessive bleeding.Many natural and over-the-counter products can thin the blood and increase a person's risk of bleeding.Newer oral direct anticoagulants may be safer alternatives to warfarin as they have fewer drug interactions. Some people find that they also cause fewer side effects.
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