Thanks to all the pharmaceutical marketing we hear every day, most people are aware of a category of medications called blood thinners. But it’s not always clear from these commercials exactly what they are and what they do . . . and, furthermore, who should take them.
Oral anticoagulants (that is, blood thinners) are used for patients who have been diagnosed with atrial fibrillation (AFib), and who have risk factor(s) for a stroke. Atrial fibrillation is an irregular or abnormal heart beat from the top part of the heart. The irregular beats make it more likely to develop a clot in the heart, which can travel to the brain and cause a stroke.
Over the last number of years, the only choice in stroke prevention medication or blood thinners was warfarin, a vitamin K antagonist, also known as Coumadin. It has been the mainstay of treatment for the past 50 years. Although effective for stroke prevention, warfarin requires frequent blood testing, has multiple drug interactions and certain food restrictions like leafy green vegetables, for example, because they contain a large amount of vitamin K. Vitamin K has the effect of reversing the performance of the medications and, therefore, should be avoided.
Newer medications called novel anticoagulants or NOACs (pronounced No Ax) take effect more quickly. You may have heard of some of them. They go by the names Pradaxa, Xarelto and Eliquis – and they are touted for their safety, efficacy and ease of use for both patient and physician.
But these new oral anticoagulants have one drawback in common: unlike Coumadin, there is no antidote. Although this may rarely happen, it can be a potential drawback should you need emergency surgery. They do offer slightly better stroke prevention, with similar or improved overall bleeding risks, and a lower risk of bleeding in the brain.
Some health systems, including Cooper University Hospital, have an active anticoagulation committee in the hospital and have developed a reversal protocol for emergency patients.
The need for a blood thinner varies with each patient and should be discussed with your doctor. Potential reasons to be on a blood thinner may be a previous stroke, high blood pressure, diabetes, and age, along with atrial fibrillation.
Your doctor may refer you to a cardiologist for this assessment and discussion.
For more information about the Cooper Heart Institute, go to CooperHealth.org/Heart