Prescription Blood Thinners – Caution

Over the years, Coumadin (warfarin) has been the most reliable and widely used medication, but also has the dubious distinction of topping the list of medication-related emergency hospitalization for seniors. In my cardiology practice, I was always wary of blood thinning medications and used them with considerable caution, as of course would any doctor. Often the bleeding that occurs is a result of unintentional overdosing. When the situation allowed, I would use natural blood thinning supplements, such as omega-3 fatty acids and nattokinase, but in critical cases medication was necessary.

Since I retired from active practice, a new generation of prescription blood thinners have been approved for patients with atrial fibrillation who have a high risk for stroke from blood clots. The most popular drug in this group is Pradaxa (dabigatran). I personally don’t have experience with this medication but have spoken to cardiology colleagues about it, as well as followed the research.

As of 2014, the research on dabigatran indicates that it has an overall favorable safety profile, said to be comparable or even better than Coumadin (warfarin). However, bleeding risks are real in this class of drugs, and emergency rooms are reporting treating an increased number of individuals with bleeding related to dabigatran use. The reports describe more gastrointestinal bleeding but less cranial bleeding, and with more benign symptoms, when compared to warfarin.

According to the U.S. Food and Drug Administration, the use of dabigatran may heighten the risk of bleeding for the following patients:

• Individuals over 75 years old;
• Someone with kidney problems;
• Someone who has stomach or intestine bleeding that is recent or keeps coming back, or has a stomach ulcer;
• Someone who is taking other medicines that increase the risk of bleeding, including other prescription blood thinners;
• Aspirin or aspirin-containing products, non-steroidal anti-inflammatory drugs (NSAIDs);
• Kidney patients taking dronedarone (Multaq®) or ketoconazole tablets (Nizoral®).

Work Closely with Your Doctor

Whenever considering any blood thinning, anti-clotting medication, the benefit-to-risk ratio must always be seriously considered, and blood monitored routinely according to the doctor’s instructions.

If you already take such medication and experience any unusual bruising, a classic sign of too thin blood, immediately inform your doctor who may need to reduce the dosage. Don’t delay and don’t pretend it isn’t so and that you may be mistaken. For your own good, err on the side of caution and safety. Your life could depend on it.

Too much blood thinning can cause bleeding, and the risk is going to be naturally higher among the elderly with diminished ability to clear these medicines from the body. You can bleed into the skin and bruise easily. You can bleed from the gums. You can bleed into your urine, which would give a straw color to the urine, or into your intestines. Clearly though, the most devastating bleeding occurs as bleeding in the brain that can manifest as a devastating or deadly hemorrhagic stroke.

References and Additional Resources:

• Budnitz DS, Lovegrove MC, et. al. Emergency Hospitalizations for Adverse Drug Events In Older Americans. N Engl J Med. Nov. 24, 2011;365:2002-2012.
• Bloom BJ, Filion KB, et. al. Meta-Analysis of Randomized Controlled Trials on the Risk of Bleeding with Dabigatran. Am J Card. Mar. 15, 2014;113(6):1066-1074. [Abstract.]
• Berger R, Salhanick SD, et. al. Hemorrhagic Complications In Emergency Department Patients Who Are Receiving Dabigatran Compared With Warfarin. J Ann Emerg Med. Apr. 2013;61(4)475-479. [Abstract.]
• U.S. Food and Drug Administration web site. Medication Guide: Pradaxa. FDA.gov, accessed July 30, 2014.

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