There are a number of reasons your doctor might prescribe a blood thinner: if you are at risk of blood clots because you’ve recently had a surgery; if you’ve had a heart valve replacement; if you have certain heart or blood vessel diseases; or if you have a congenital heart defect. Blood thinners are also used for people with abnormal heart rhythms: atrial fibrillation (afib). This category of drug helps stop blood clots from forming or keeps existing clots from growing. They’re important drugs because blood clots can lead to life-threatening heart attacks, strokes, and other blockages.
Blood thinners include both antiplatelet drugs such as aspirin, Plavix (clopidogrel bisulfate), Brilinta (ticagrelor), and Effient (prasugrel), as well as anticoagulants such as the older drugs warfarin (Coumadin, Jantoven) and newer drugs Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), and Savaysa (edoxaban). Your doctor will consider certain risks before prescribing one for you, but newer anticoagulants are generally safer and easier to use than the older ones.
Antiplatelet drugs work differently from anticoagulants. Antiplatelet drugs block the release of the hormone thromboxane, which signals blood cells to clump together (and may cause clotting), whereas more aggressive anticoagulants interfere with the production of the proteins in blood that actually make it possible for blood cells to clot.
But blood thinners come with a number of risks and serious side effects, too, if not used properly — particularly anticoagulants.
Typically individuals don’t want their blood to clot, because such blockages can quickly cause severe circulation and heart problems. But if you get cut, you do want the body’s blood cells to naturally clump together so you stop bleeding. Blood thinning medications will interfere with this process, potentially turning minor injuries into big problems.
The good news is, says Mario Garcia, MD, the chief of cardiology at Montefiore Medical Center and Albert Einstein College of Medicine in New York City: “The vast majority of patients who take blood thinners can lead completely normal lives.”
But anyone taking a blood thinner should be aware of a few precautions that can lower the risk of their medications turning a small problem into a larger one. Things like diet, the types of physical activity you do, proper dosing and monitoring for the blood thinner you’re taking and other medications can all affect your risk of blood thinner side effects. All these topics are good ones to discuss with your doctor if you’ve been prescribed a blood thinning medication.
Your lifestyle will play a role in your doctor's decision to prescribe blood thinners or not. Most people who take a blood thinner on an empty stomach at the same time every day and follow a relatively stable diet will do fine, Dr. Garcia says. But he also recommends drinking alcohol only in moderation. Binge drinking could cause drastic fluctuations in how long it takes your blood to clot, and could also lead to falls or accidents, which could increase the risk of blood thinner side effects, like excessive bleeding. Elderly people who live alone are at increased risk for falling and injuring themselves, so blood thinners may not be right for them. Instead, Garcia says, doctors may recommend an aspirin.
Your body makes clots and prevents bleeding by using vitamin K, and blood thinners work by blocking vitamin K–dependent clotting factors. That means a diet rich in vitamin K, which is found in leafy green vegetables, like spinach and kale, will diminish the effect of an anticoagulant blood thinner such as warfarin. You can reduce the amount of vitamin K you get in your diet by choosing iceberg lettuce over baby spinach in salads, but you don’t have to completely avoid it, Garcia says. Rather, aim to get about the same amount of vitamin K every day to avoid fluctuations in the effectiveness of your blood thinner and avoid side effects.
Exercise helps lower your risk for stroke and heart failure if you have atrial fibrillation, so being physically active regularly is a good thing. But if you fall or injure a joint when you’re on a blood thinner, there’s a greater chance you’ll have bleeding inside the body, which is very painful, Garcia says. It’s a good idea to avoid contact sports while taking any blood thinner, and always wear a helmet when skiing or cycling.
Blood thinners can prevent harmful clots, but they don't stop blood from clotting completely. Weekly or monthly blood tests to determine your international normalized ratio (INR) will help your doctor adjust your blood thinner dose for the correct level of anticoagulation. Although new devices allow some patients to do this at home, many may still need to go to a clinic regularly. And it’s always important to have access to your doctor in case you have a question or at-home tests indicate a problem.
Telling your doctor about all other medications and supplements you take is essential because of the possibility of a drug interaction that could lead to dangerous side effects. Doctors are concerned about mixing warfarin with antibiotics because antibiotics can eliminate the bacteria in the gut that produce vitamin K, making a blood thinner more potent, Garcia says. But if you’re on a newer anticoagulant — like Pradaxa (dabigatran) or the factor Xa inhibitors Xarelto (rivaroxaban), Eliquis (apixaban), and Savaysa (edoxaban) — vitamin K levels won’t interfere with effectiveness. Common over-the-counter pain relievers, cold medicines, and stomach remedies can all interfere with blood thinners, as can any medicines containing aspirin, which is why it’s important for your doctor to know everything you’re taking before you start on a blood thinner.
Doctors are also concerned about drugs that can cause irritation and bleeding in the stomach, such as arthritis medications.
If you work in a high-risk profession — as a racecar driver or a lumberjack or construction worker who uses heavy machinery, for example — you would be well advised not to take a blood thinner, Garcia says. Or you should avoid those high-risk tasks while on the medication.
This advice would only apply to someone with a high risk of trauma while they work. In most cases, your job shouldn’t prevent you from taking a blood thinner, Garcia adds.
Taking an anticoagulant protects you from the blood clots that could develop during several hours of travel on a plane or in a car. But if you’re going to be away for several weeks and you’re on an older-generation blood thinner drug that needs frequent blood tests, you'll need to find a clinic where you can have your blood monitored, Garcia says.
Additionally, try to keep your dietary habits stable while on vacation to avoid fluctuations in the effectiveness of your medication.
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