Understanding “blood thinners”

Nearly everyone has heard of “blood thinners.” Maybe you or someone you know takes one. But these drugs don’t “thin” blood at all.

“They are actually anti-clotting drugs,” says Dr. Gregory Piazza, a cardiologist with Harvard-affiliated Brigham and Women’s Hospital. “They prevent potentially dangerous blood clots from developing in people at high risk, like those who have atrial fibrillation or a stent in a blood vessel, or who are immobile after surgery.”

A clearer look at clots

A clot has two main components: fibrin and platelets. Fibrin is a protein that forms a mesh to trap red blood cells, while platelets are tiny cells that clump together. They work together to keep the clot intact and stop or slow blood flow. (Picture how a large rock disrupts the flow of water in a stream.)

When you get a cut, a clot forms to stop excessive bleeding. However, clots also can form in areas where they lead to harm and potentially death.

Typically, a clot dissolves after a cut has healed. But a blood clot that forms inside an artery or vein might not spontaneously dissolve, and it can even grow larger. As a result, it can block blood flow, which may lead to a heart attack or stroke.

Many factors contribute to these types of clots, such as inflammation, infection, immobility, cancer, surgery, or other predisposition to clot formation.

“In these cases, you need anti-clotting drugs to help the body dissolve the existing unwanted clots and stop new ones from forming, while still allowing the blood to clot when needed, like after an injury,” says Dr. Piazza.

Different drugs

Anti-clotting drugs fall into two main categories: anticoagulants and antiplatelet drugs. Which one you need depends on your clot risk. Here is how they work and when doctors choose which type.

Anticoagulants. These drugs interfere with fibrin. Besides treating and preventing clotting in veins, like deep vein thrombosis (DVT), they are often prescribed for people with atrial fibrillation (afib). Afib is a rapid, irregular heart rhythm that causes blood to pool in the heart’s upper chambers. The stagnant blood can promote the formation of clots; a clot that slips out of the heart and travels to the brain can cause a stroke. Anticoagulants help stop the formation of these clots, thereby reducing stroke risk.

Antiplatelet drugs. These prevent platelets from sticking together. They are used to avert heart attacks and strokes in people who have cardiovascular disease or are otherwise at high risk.

Dosage and needs

How long you need anti-clotting drugs and how much you should take depend on your needs. For example, people typically take two antiplatelet drugs for six months to a year after getting a stent (a tiny metal mesh tube that is inserted into a clogged blood vessel to increase blood flow). Then they stay on just one antiplatelet drug, usually low-dose aspirin, indefinitely.

People who have afib may take anticoagulants for the rest of their life. Other situations require only short-term drug therapy. Many people take anti-clotting drugs after orthopedic surgery, like knee or hip replacement, for 14 days to six weeks to prevent DVT.

Sometimes people need to take both an anticoagulant and an antiplatelet drug at the same time if they are being treated for separate issues — for instance, afib and a stent. Doctors may prescribe an anti-clotting drug for some patients hospitalized with COVID, as research has shown the virus increases the risk for blood clots.

Watch for bleedingThe most significant risk of anti-clotting drugs is excessive bleeding. When you take them, it’s important to contact your doctor if you notice any of these symptoms:recurrent bleeding in you gums after you brush or flossnosebleeds or minor cuts that take longer than usual to stopfrequent bruising, especially around the trunk.tea-colored or red urine (possible urinary tract bleeding)black, tarry, or red stools (possible gastrointestinal bleeding)

Certain conditions apply

Who should be careful with anti-clotting drugs? People ages 75 and older have a higher risk of bleeding as a side effect, according to Dr. Piazza. (See “Watch for bleeding.”)

Over-the-counter pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) can interact with anti-clotting drugs, so check with your doctor before taking them.

People who take the anticoagulant warfarin (Coumadin) need to be consistent about their consumption of vitamin K–rich foods like spinach, kale, broccoli, and Brussels sprouts.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”     

2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”

1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.

Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.

Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.

Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.

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