6 things to know when starting blood thinners

Blood thinners, also referred to as anticoagulants, are a class of medications that interfere with the body’s clotting process. They work by helping break down existing clots or reducing the likelihood of clots forming in the first place.

“By preventing blood clots, blood thinners help prevent emergencies such as strokes, heart attacks, and pulmonary embolisms,” explained Austin Chen, a registered pharmacist with Express Scripts^® Pharmacy.

Blood thinners are prescribed for several different health conditions, including:

• Abnormal heart rhythms ­— Atrial fibrillation (irregular and often very rapid heart rhythm) can cause blood to pool in the heart’s chamber, increasing the risk of clots forming. Blood thinners can help reduce the risk of clots.
• Deep vein thrombosis (DVT) — DVT is a condition in which a clot forms in deep veins, most commonly in the leg. Blood thinners are used to prevent the clot from growing or breaking loose and traveling to the lungs, causing a pulmonary embolism (blood clot in the lungs).
• Patients with a history of prior heart attacks of strokes — By preventing blood clots in the coronary arteries, blood thinners can reduce the risk of having another heart attack or stroke.

Types of blood thinners

There are several different types of blood thinners:

• Vitamin K agonists like warfarin interfere with the body’s use of vitamin K, which is necessary for blood clotting.
• Direct oral anticoagulants (DOACs) such as Eliquis^® (apixaban), Pradaxa^® (dabigatran), Xarelto^® (rivaroxaban), and Savaysa^® (edoxaban) directly target specific clotting factors in the blood.
• Antiplatelet medications like low-dose aspirin and Plavix (clopidogrel) work to prevent platelets from sticking together, reducing the risk of clots from forming.

“Most blood thinners are taken orally at home, but there are some blood thinners that are typically administered in a hospital setting via intravenous or subcutaneous injections, such as heparin and Lovenox^® (enoxaparin),” said Chen.

Understand the risks with taking blood thinners

Starting blood thinners is a significant medical decision and comes with its own inherent risks. It’s important to be well-informed and work closely with your healthcare team throughout the process.

Here are six things you should be aware of before starting blood thinners.

1. Watch for excessive bleeding.

Because blood thinners reduce the body’s natural ability to clot, simple bumps and scrapes may result in bruising or prolonged bleeding. Patients should keep an eye out for bleeding that won’t stop, such as from their gums, nose, or cuts and scrapes.

In the event of a cut, make sure to hold pressure over the cut with gauze, and elevate the cut above heart level. If the cut is still bleeding after 15 minutes, try applying an over-the-counter product like QuickClot^® or BleedStop^TM. If none of those suggestions are helping, call 911 or visit your nearest emergency room.

“Patients will want to avoid rough sports and high-contact activities, as these may place you at higher risk for bruising and internal bleeding,” said Chen. “Patients should also be aware of signs and symptoms of internal bleeding. Slow bleeding may present as fatigue, shortness of breath, pale skin color, and dark, tarry stool. Rapid bleeding can cause stroke symptoms or abdominal and back pain.”

2. You may feel sick.

An adverse effect from blood thinners is a lower blood count in your body. As a result, patients may experience nausea, weakness, dizziness, and fatigue.

3. Be mindful of medication interactions.

Always talk to your doctor before starting new medications, even over-the-counter medications and supplements.

Some medications, foods, and dietary supplements can interact with blood thinners, potentially affecting how they are metabolized or increasing the risk of side effects like feelings of sickness or discomfort.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen can increase the risk of bleeding when used in conjunction with blood thinners.
• Certain antibiotics like Bactrim, ciprofloxacin, metronidazole, and clarithromycin affect how blood thinners are metabolized.
• Some antifungal medications can increase the risk of bleeding.
• Herbal supplements like ginkgo biloba, garlic, and vitamin E can have blood thinning properties and raise your risk of bleeding if you take blood thinners. Ginseng, coenzyme Q10, and St. John’s wort may decrease the effectiveness of the blood-thinning medication.
• Vitamin K, whether as a supplement or from dark-green, leafy vegetables, is particularly dangerous if you take warfarin.
• Alcohol, cranberry juice, and grapefruit can also interact with blood thinners, affecting how the medication is metabolized and increasing your risk of bleeding.

4. Keep all healthcare providers informed.

“Your pharmacist, dentist, and even ophthalmologist should all be aware if you are taking blood thinners,” said Chen.

Patients should inform their dentist so they take extra care during checkups. If oral surgery needs to be performed, your dentist will weigh the risk of bleeding against the risk of blood clot for the procedure. Also, your gums are delicate, so brush your teeth with a gentler touch, use a soft toothbrush, and try waxed dental floss.

Generally, blood thinners won’t affect cataract surgery, but it’s still a good idea to inform your eye doctor so they can help reduce side effects.

5. Don’t miss a dose.

“Some blood thinners will need to be taken on a strict schedule,” warned Chen.

If you do miss a dose for whatever reason, you can log in to your account at express-scripts.com/rx and select the medication name to find answers to frequently asked questions, including what to do if you miss a dose. Alternatively, you can check the patient information that was provided with your medication. It usually contains specific directions for what to do if you miss a dose.

If you’re still unsure, we recommend contacting your doctor or pharmacist. They can advise you on next steps.

6. Take extra safety precautions.

Blood thinners increase the time it takes for your blood to clot. While this is beneficial for the medical conditions mentioned above, it means that any injury that causes bleeding can be more serious.

When you’re on blood thinners, Chen recommends being cautious using knives, razors, or any sharp objects that can cause bleeding. He also suggests avoiding trimming your fingernails or toenails too deeply, wearing gardening gloves when doing yard work, and considering wearing non-skid slippers in the house to avoid falls.

Express Scripts^® Pharmacy is here to help

We understand the challenges that come with starting a new maintenance medication. That’s why our dedicated team of registered pharmacists are available 24/7, 365 days a year, to answer any questions or concerns.

Our pharmacists may also be able to help you save money on your medications by providing you with lower-cost options.