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What are blood thinners? A question asked by virtually every patient at some point in time. Although we all wish there was an easy, one sentence answer, the truth is that the topic of blood thinners is very complex. There are various types of blood thinners and various reasons doctors may recommend blood thinners for you. Blood thinner “rules” or “reasons” for use are often filled with many exceptions related to your medical history. You should never start or stop taking blood thinners before talking to your doctor. Below we will discuss what blood thinners are and explain the most common blood thinners used in everyday medical practice.

Types of Blood Thinners

Blood thinners can be grouped into two main categories, antiplatelet agents and oral anticoagulants. In general, both aim to prevent blood clots, but they do so in different ways. Essentially, the same end goal but different means to reach that end goal. Blood clots are important to prevent because they can lead to a heart attack or a stroke. 

Antiplatelet Agents

Antiplatelet agents specifically alter your platelets (a type of blood cell) function. They generally delay your blood from clotting by prohibiting your platelets from sticking together. This lack of sticking stops any form of bleeding and since your body is not bleeding, it prevents your blood from clotting. Antiplatelet agents typically include, aspirin, ticagrelor (Brilinta), clopidogrel (Plavix), prasugrel (Effient) and aggrenox. Each of these medications have been widely used for years and are all generally considered highly effective.

Oral Anticoagulants

Oral anticoagulants are blood thinners that also prevent blood clots but do so in a different way. Your liver produces factors that help your blood clot. Oral anticoagulants prevent your blood from clotting by inhibiting the clotting factors produced by your liver. Instead of interrupting your platelets (a type of blood cell) from sticking together (like antiplatelet agents), oral anticoagulants inhibit the clotting factors from your liver. These typically include, warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto). 

Antiplatelet agents and oral anticoagulants are similar to each other as they both prevent your blood from clotting, but they do so in a completely different mechanism of action. In some cases, because of the need to inhibit both platelet and other clotting factors, patients may be placed on both of these blood thinners. For completely different, yet equally important reasons, your doctor will decide what therapy is best for your situation.

Determining Which Blood Thinner to Use

(This is a submitted patient question for KHC University; click here to suggest one!) 

Many times, the choice of which blood thinner to use is determined by your medical history. For example, if you have a mechanical heart valve then warfarin (Coumadin) is the preferred agent not because another agents will not work but because the other agents have not been studied sufficiently to be used in certain conditions. In patients with long standing atrial fibrillation, oral anticoagulant agents (NOT antiplatelet agents) may be used. The type or brand (Coumadin, Eliquis, Pradaxa, etc.) is usually determined by the patient’s preference or affordability of the medication. 

Cardiovascular Reasons for Blood Thinners

Generally, cardiologists prescribe blood thinners based on your medical history. For example, an individual who recently had a stent placed in his or her coronary artery requires antiplatelet agents to help keep the stent from closing down. Alternatively, a patient without a prior stent or bypass surgery who has atrial fibrillation may require oral anticoagulants alone. These two strategies are completely different and each is geared at preventing either another heart attack or stroke associated with atrial fibrillation.

Patients undergoing surgery who take either form of blood thinner should always consult with their cardiologist or primary care physician to receive direction on how to take their blood thinner medications. Since blood thinners do just that, thin your blood, you may be required to temporarily stop taking them to avoid excess bleeding. This is a general example of what could be needed. In other cases, the continuation of blood thinners may be both safe to continue or potentially harmful if they are stopped inappropriately. Each case is different and there are no hard and fast rules that apply to everyone as each person’s medical history and risk is different. Therefore, you should never start or stop your blood thinners before talking to your doctor. 

Are Blood Thinners Temporary?

In general, the duration for a specific blood thinner is related to the condition for which it is being utilized. A patient who has received a stent will typically require a blood thinner for 12 months, while someone with long standing atrial fibrillation may require a blood thinner for the remainder of his or her life. There are many exceptions to both of these guidelines and as a result, it is always best to consult with your doctor to develop a plan and timetable for the duration of your blood thinner.

Side Effects of Blood Thinners

As you would expect, the major side effect of any type of blood thinner is bleeding since blood thinners aim to prevent your blood from clotting (which stops bleeding). Overall, this is a rare complication, but it can be quite serious for some patients. If you notice frequent nose bleeds, blood in your stool or urine or vomit that contains bright blood, it is always necessary to seek medical attention for an evaluation. Many times, the bleeding is trivial and requires no intervention, but again, it is best to have a conversation with your physician to receive some guidance.

There is no evidence that taking a blood thinner for a prolonged period of time in anyway is harmful to your health as a whole. This being said, the older you are while taking a blood thinner, the more likely you are to have a bleeding complication. While this is true, you should NEVER stop any of these medications without the direction of your doctor. Inappropriate discontinuation of these medications can result in serious illness, most notably a heart attack, a stroke and blood clots in your lower extremities.

As you can tell, the topic of blood thinners is not simple. For every rule there is an exception. Since each individual is different and has a different medical history, you should talk to your doctor to find out more specific medical reasons for why your doctor does or does not prescribe blood thinners for you. We hope this short session has increased your understanding of blood thinners, outlining some of the indications, risks and benefits. Thank you for being part of KHC University and don’t forget to suggest a topic below!

As always, thanks for letting us kare for your heart!

Transesophageal Echocardiogram (TEE)

A transesophageal echocardiogram (TEE) is an invasive heart procedure where an ultrasound probe is inserted into your esophagus (food pipe). A transesophageal echocardiogram allows your cardiologist to acquire detailed pictures pertaining to the structure, function and any valvular heart disease that many be present. This procedure demonstrates your cardiac function in much greater detail than a standard transthoracic echocardiogram.

Prior to your procedure, you should not have any food or drink for 8-12 hours. In most cases, you will be able to take your home medications as scheduled. Your cardiologist / healthcare provider will advise you if there are any requirements to alter your medication schedule. Prior to your transesophageal echocardiogram, the technologist will insert an IV in your arm as a safety precaution to begin the test. This will allow sedation to be given to make you more comfortable during your procedure. During your procedure, you will be required to lie flat for approximately 30 minutes while the test is being completed. After your transesophageal echocardiogram, you will need to refrain from driving for approximately 12 hours and will need someone to accompany you home after the procedure. You can return to your normal activities the morning after your procedure.