Thin Line of Safety for Blood Thinner Users

Shortly after an otherwise successful hip replacement, my neighbor ended up in the hospital when he cut himself shaving. Just a minor cut, but it bled excessively. The problem? His physician had prescribed the blood thinner warfarin (Coumadin) to prevent blood clots, which are far more likely to occur when you are off your feet and relatively immobile following surgery. When you are taking a blood thinner, otherwise minor cuts can suddenly become major bleeds, especially if you and your doctor have not yet arrived at the proper dosing level for you with these very sensitive drugs.

SERIOUS HEALTH CHALLENGES

According to a recent survey by the National Consumers League (NCL), my neighbor's situation was not unique, and people who take prescription blood thinners typically face far more serious challenges than previously believed. These drugs -- most commonly prescribed for individuals who are at risk of stroke, have mechanical heart valves, suffer from atrial fibrillation (a heart rhythm disturbance), or who have had recent knee or hip replacement surgery -- may successfully prevent life-threatening blood clots. However, blood thinners are also especially difficult to manage in terms of balancing the dosing, the effectiveness and side effects, observes assistant professor and public policy expert Larry Sasich, PharmD, MPH, of the Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy in Erie, Pennsylvania.

Blood thinners may cause adverse reactions such as bruising, bleeding and dizziness, and interact dangerously with other drugs, vitamins, supplements and foods. The reactions often include dramatic changes in blood pressure that may, in severe cases, precipitate shock and death. Additionally, like my neighbor, if a patient is not coached in first aid to control the bleeding by his/her doctor, even a minor cut can create a medical emergency. Frighteningly, even though the vast majority of participants in the NCL survey reported adverse reactions of one kind or another, more than half admitted that they had done nothing about them. Fortunately, the good news is that there are specific steps you can take to ensure that blood thinners function properly, thus minimizing your risk of dangerous adverse effects, says Dr. Sasich.

GET REGULAR BLOOD TESTS

As mentioned above, blood thinners are tricky business. Blood thinners are effective within a very narrow range, and even a slight variation outside this range can pose significant health risks. To stay safe, regular blood testing is critical, notes Dr. Sasich. These tests measure how fast your blood clots and is known as your international normalized ratio (INR), which usually falls somewhere between 2 and 3. If the number is off, problems can develop and the physician will adjust your dosage accordingly. At the onset of treatment, testing is required on a weekly or sometimes even daily basis. As time goes on, you may only need monthly testing.

NATURAL WAYS TO KEEP YOUR BLOOD FLOWING

Given the complexity of blood thinners, I asked Daily Health News contributing editor, Andrew L. Rubman, ND, if there are any supplements or lifestyle choices that people can make that will help keep their blood flowing healthfully and perhaps reduce or remove the need for blood thinners. Dr. Rubman's reply: While there are some measures you can take to help keep your blood flowing healthfully, keep in mind that some of the risks, such as bleeding, still exist even when taking natural products. Given the complexity of blood-thinning strategies, Dr. Rubman recommends that individuals coordinate their care with both MDs and naturopathic physicians. There are assorted treatment options, and the patient's needs may vary over time due to both individual body changes as well as external factors, such as pending surgery or dental work.

TELL YOUR DOCTOR ABOUT ALL DRUGS AND SUPPLEMENTS YOU TAKE

Whether you are using natural or pharmaceutical products to help keep your blood flowing healthfully, other medicines, vitamins and herbal supplements can interact dangerously with blood thinners, changing the way they work in your body, warns Dr. Sasich. These substances can affect clotting in either direction, rendering it either too likely or not likely enough to occur. As a result, it is absolutely essential to tell your doctor about all substances you take. Dr. Sasich cautions that you must pass on this information before you begin taking blood thinners. Also inform your pharmacist, who is better trained in possible interactions.

CONSISTENCY IN DIET IS KEY

Significant changes in diet also affect the way blood thinners work in the body. For example, if you start eating lots of foods rich in vitamin K (which is the vitamin that affects blood clotting) -- e.g., green vegetables such as spinach or broccoli -- your INR number may drop below 2, at which point the blood may clot too quickly. On the other hand, suddenly cut back on leafy green veggies, and you can raise the INR over 3, which means the blood may clot too slowly and raise your risk of severe bleeding. Note: People should consult with their doctor if they drink alcohol, as it may also have an effect.

Importantly, this does not mean that veggie lovers should give up their greens if they already eat them on a regular basis, stresses Dr. Sasich. He points out that the watchword here is consistency. Do not make radical changes in your diet one way or the other without informing your physician.

PAY ATTENTION TO WARNING SIGNS

When you are taking a blood thinner, it is normal to be more vulnerable to getting bruises. However, promptly report any large bright red or sudden or unusual forming bruises to your physician, advises Dr. Sasich. If you experience even a minor cut or nosebleed that won't quit bleeding, he recommends that you immediately check with your doctor or go to the emergency room.

Also critical is to suspend use of blood thinners before any medical procedure -- including dental cleanings -- that might cause bleeding. Check with your doctor for how and when to adjust your dosing for the procedure. If you have a hard fall, check with your doctor, because it can cause internal bleeding.

DO YOUR HOMEWORK

Doctors and other caregivers need to make a more concerted effort to inform patients how to use blood thinners safely, emphasizes Dr. Sasich. In the meantime, however, it's up to you to do your own homework. Ask questions of both your doctor and pharmacist, read the drug inserts and make it a habit to inform all health-care providers about all the products you take, whether prescription or over-the-counter. You can also learn more about blood thinners at the NCL Web site, www.mybloodthinner.org

Be well, Carole Jackson, Bottom Line's Daily Health News;   http://www.bottomlinesecrets.com/

Sources:

Thin Line of Safety for Blood Thinner Users

Larry Sasich, PharmD, MPH, assistant professor, public policy expert and pharmaceutical research analyst, Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy, Erie, Pennsylvania.
Andrew L. Rubman, ND, adjunct professor of clinical medicine, Florida College of Integrative Medicine, Orlando, and director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.
National Consumers League, www.mybloodthinner.org