If you or someone you love has some form of heart or blood vessel disease…or if you’ve had or are at risk of having a stroke…a blood thinner may be living in your medicine cabinet. Put simply, blood thinners keep your blood from forming clots in any part of your body.
But do you really know what they do? Not all blood thinners work the same way. Here’s what you need to know.
WHAT’S SO BAD ABOUT CLOTTING ANYWAY?
Clotting is something your blood does naturally—and it’s important. Without the ability to clot, a simple cut could cause you to bleed excessively. When you bleed, platelets—small disk-shaped parts of bone marrow cells that circulate in your blood—release a chemical called thromboxane that “calls out” to other platelets to come help. These platelets stick together and stop the bleeding.
But there are times when clotting is not your friend. Some clots are caused by injury, or they can form in arteries where there’s no obvious injury. Other clots, such as deep vein thrombosis (DVT) may happen after prolonged sitting. Family history also plays a role in how likely you are to have blood clots. Clots near the heart can cause a heart attack, while those that travel to blood vessels in your brain can cause a stroke. That’s where blood thinners come in—they keep platelets from “overdoing it.”
There are two main types of blood thinners…
Antiplatelets are what the name implies…they keep platelets from clumping together and forming clots. They also break up existing clots. They are often the first type of blood thinner your doctor may suggest.
Best for: Antiplatelets are a more conservative option than anticoagulants, so they are often the first approach that health-care professionals recommend. They are often recommended for patients who have either had, or are at high risk of having, a myocardial infarction (a heart attack caused by clot) or an ischemic stroke (caused by a clot).
- OTC prevention: Over-the-counter aspirin tablets are antiplatelets. Many people at risk for heart attack take low-dose aspirin daily to prevent heart attacks. The benefits need to be balanced against the risks, especially for gastrointestinal bleeding. (Fortunately, there’s an app for that.)
- Omega-3 fatty acids also act as antiplatelets. While many people take omega-3 capsules as a dietary supplement (a typical daily dose is 1,000 mg), some health-care professionals recommend higher doses to help prevent blood clots for cardiovascular patients—for example, after a heart attack. Because antiplatelets raise bleeding risk in some people, however, anyone taking more than 3,000 mg per day should do so only in consultation with a health-care professional, according to the American Heart Association.
- Prescription option: People who have already had a heart attack or stroke, or have another cardiovascular condition such as unstable angina, may be prescribed the medication clopidogrel (Plavix) to prevent a future heart attack or stroke. It’s also an antiplatelet.
Anticoagulants also work to keep blood clots from forming, in this case by targeting certain proteins that are important to the clotting process.
- Best for: These are more effective than antiplatelets but also have more side effects, so doctors prescribe them for specific reasons. People who have had “mini strokes,” also called transient ischemic attacks (TIA), or those who have atrial fibrillation (Afib), which is an abnormal heart rhythm, are often prescribed anticoagulants. They can also be helpful if you’re at risk for deep vein thrombosis, a clot that forms in a deep vein that may travel to your lungs. (Warning: Some people with Afib should not be prescribed an anticoagulant—but often are.)
- Old standby: Warfarin (Coumadin) is a prescription anticoagulant that’s been around a long time. It’s proven to reduce stroke risk. But it requires frequent blood tests to finesse the dose, plus you’ll need to avoid certain green vegetables.
- Newer entrants on the anticoagulant scene are dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). They don’t require blood tests and there are no food restrictions but they have their own unique risks. The key one: Only dabigatran has an antidote—the others can put you at risk of uncontrolled bleeding. To learn more, see the Bottom Line article, “The Truth About Blood Thinners.”
