By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
If you’ve had a stroke or are at high risk for one, or have atrial fibrillation, or deep venous thrombosis, your doctor will likely prescribe you a blood thinner. Some of the most common blood thinners are warfarin (Coumadin), aspirin, and clopidogrel bisulfate (Plavix).
What Are Blood Thinners?
Blood thinners are most often prescribed for the prevention of stroke and clots. The drugs are also prescribed after a hip or knee replacement to prevent embolisms, as was the case after my hip was replaced.
Blood thinners are technically called “anticoagulants,” because they prevent or treat coagulation, the formation of clots. I think the nickname comes from “paint thinner.”
Although advertising influences which drugs patients request from their doctors (and doctors, sadly, all too often oblige), there is no simple, cookie-cutter approach. Anticoagulation therapy needs to be individualized.
How Blood Thinners Work
Common blood thinners work in one of two ways. Coumadin, which has been around for more than 60 years and is the oldest anticoagulant drug, works the first way: by neutralizing clotting factors in the blood. Coumadin decreases blood clot formation by reducing the body’s level of vitamin K1, which regulates clotting. It has shown unparalleled ability to thin the blood and prevent unwanted blood clotting.
Other blood thinners, like clopidogrel (Plavix), work by preventing blood platelets from clumping. Platelets are irregularly shaped cell fragments in the blood that can cause sticky blood and thus enhance clotting. In my own clinical experience with Plavix, I’ve seen very few adverse symptoms. It seems to be tolerated better than aspirin as an anticoagulant.
Is Aspirin a Blood Thinner?
Another type of blood thinner, aspirin is useful for individuals with arterial disease and those who have undergone stenting or bypass surgery. Like Plavix, aspirin works by preventing blood platelets from clumping together. In such cases, doctors often prescribe aspirin, sometimes as an accompaniment to a more potent anticoagulant.
Despite its potential benefits, the only time I condone regular aspirin use is when someone has documented coronary heart disease and can tolerate the drug. (I personally can’t tolerate it.) Should you have heart disease, I suggest a full aspirin every other day, to give your system a rest and still get the best effect.
Blood thinners are a double-edged sword. While the drugs help prevent heart disease and strokes, they also raise the risk of bleeding, even a stroke-induced hemorrhage.
For many years, doctors have routinely prescribed aspirin for primary heart attack and stroke prevention. But I’ve been cautioning patients and you, my readers, to think outside that box.
Aspirin is a major cause of GI bleeding and hospitalizations, and can trigger insomnia, rapid heartbeat, and liver damage. As I’ve reported previously, an authoritative publication for doctors and pharmacists unequivocally stated that the risks of long-term aspirin use should disqualify this practice from being considered for primary prevention.
Side Effects of Blood Thinners
The major side effect of blood thinners is excessive bleeding. For that reason, doctors require routine blood testing to monitor a measurement of coagulation called INR (International Normalized Ratio). Normal clotting ability on the INR scale is 1.0. For anyone with atrial fibrillation, the therapeutic INR target for effectively reducing risk for stroke is a reading of 2–3. An excess of any single anticoagulant, or of a combination of them, has the potential to raise your number and increase the risk of bleeding.
Coumadin is the most dangerous of the blood thinners for bleeding. However, aspirin can also cause bleeding, particularly in the gastrointestinal tract, and sometimes in other tissues. One of my patients on aspirin therapy had bleeding into his eye but could tolerate the aspirin well, without any GI distress whatsoever.
With Coumadin and/or aspirin therapy, I’ve had patients develop multiple ecchymoses, purple discolorations of the skin in various parts of the body. It’s caused by blood passing from ruptured blood vessels into tissue under the skin. This is not uncommon, especially if people suffer some minor trauma to their hands, arms, or legs.
Other possible side effects include nausea, vomiting, diarrhea, fever, bruising, anemia, blood in the urine, and rash. With Plavix in particular, side effects may include flu-like symptoms, headache, dizziness, pain, diarrhea, and upset stomach or indigestion.
Blood Thinner Medications & Nutritional Deficiencies
Blood thinners (except aspirin) can cause vitamin D and calcium deficiencies that can lead to softening, weakening, and thinning of bones. With elderly patients who suffer from atrial fibrillation and take Coumadin, one of my biggest fears has always been this: What if they were to fall and fracture a hip, or even worse, crack their heads and suffer a fatal subdural hematoma?
I’ve seen these things happen. In treating such cases, cardiologists are always engaged in a challenging and delicate balancing act. However, taking supplements to counteract the depletions can help to avert disaster.
I recommend patients on blood thinners take daily supplements of 2,000 IU of vitamin D, and calcium: 100 mg for men and 200 mg for women. Although green leafy vegetables, a rich source of vitamin K1, are usually restricted, I allow my patients to have a 4-ounce serving three or four times per week.
I also recommend shoring up one’s vitamin C status. Blood thinners can deplete this fundamental nutrient, which might contribute to spontaneous bruising, loose teeth, and swollen and bleeding gums. Aspirin alone can cause a deficiency of folic acid, vitamin C, iron, sodium, and zinc. Follow a foundation vitamin/mineral program containing vitamin C, folic acid, and zinc.
Who Should Take Blood Thinner Meds
If you have a prosthetic heart valve (metal or plastic), Coumadin is the only anticoagulant to take, and you must take it. No ifs, ands, or buts.
If you have atrial fibrillation, you need a blood thinner, and Coumadin is usually prescribed. If you don’t have an enlarged left atrium or significant mitral regurgitation, consult with your doctor about using a combination of aspirin and the nutritional supplement nattokinase (see Alternatives).
Who Should Not Take Blood Thinner Drugs
Anyone who has a stomach ulcer, hemophilia, or any other condition that may cause bleeding should not take blood thinners. Coumadin and Plavix should not be used by people who have high, uncontrolled blood pressure.
I wouldn’t give a prescription blood thinner to someone with atrial fibrillation who is over 90 and is unsteady on their feet, because their risk for falling injuries trumps stroke prevention. But if that same person has a mechanical (metallic or plastic) valve, Coumadin therapy is a must. Aspirin won’t cut it because it isn’t strong enough.
Recently, the Food and Drug Administration approved a German blood thinner, Pradaxa (dabigatran etexilate). The first of a new generation of anticoagulants, it is designed to prevent stroke and blood clots in people who suffer from atrial fibrillation that is “non-valvular,” meaning not due to a heart-valve problem. In the United States, the drug maker estimates that about 95 percent of atrial fibrillation cases are non-valvular.
Previously, Pradaxa has been marketed in Europe. Only time will tell how much better the new anticoagulant works, compared to Coumadin. Some downsides of Pradaxa include bleeding in the elderly and renal impairment in younger people. More new anticoagulants have recently entered the market, including Xarelto (rivaroxaban), Eliquis (apixaban), and Savayasa (edoxaban).
Patients with stents, including drug-eluting (medicated or drug-coated) stents, need long-term anticoagulation therapy to prevent the danger of clotting at the stent site. Plavix is necessary for anyone with a drug-eluting stent.
Alternatives to Anticoagulants
In my practice, when elderly people need a blood thinner, I often put them on nattokinase (50 mg twice a day) and fish or squid oil (1–2 grams daily). But beware, never take nattokinase with Coumadin. Anyone taking Coumadin, Plavix, or aspirin can take the same dose of fish or squid oil but should be sure not to take more than 2 grams daily.
These are other suitable alternatives to try: garlic (1–2 grams daily) and ginger in the form of a daily tea. You can boil diced ginger, adjusting the strength to your taste, or buy ginger tea at a health food store. However, if you want to try any alternatives, you must always work with your doctor.
Earthing (grounding) is another great, natural method to prevent red blood cell clumping and improve zeta potential (a measure of blood stickiness). We know that anybody on a pharmaceutical blood thinner who is Earthing themselves must work closely with their doctor to monitor their INR level and avoid too much thinning of the blood.
This article originally appeared in the June 2011 issue of Dr. Sinatra’s monthly written newsletter, Heart, Health & Nutrition. HMDI has reprinted this article with permission from Healthy Directions, LLC, and since adapted it © 2011 Healthy Directions, LLC, 2016 Healthy Directions, LLC and HeartMD Institute. All rights reserved.