Prevent Blood Clots

by Dr. Stephen Sinatra
Filed Under: Heart Health, Circulation
Last Reviewed 02/06/2014

Many people trying to prevent blood clots are taking the blood thinner, Coumadin. But…

There’s something about Coumadin and its cousins that elicits an “anything-but-that-Doc” response from about half the folks who are on it. Many of my patients have asked to discontinue Coumadin because, in addition to the side effects and fear of bleeding, they dislike the nature of the drug (it’s rat poison in high quantities), as well as the discomfort and inconvenience of blood tests every 4–6 weeks.

In fact, whenever I lecture, someone in the audience always asks: “Is there some alternative to Coumadin?” So, let’s review anticoagulants like Coumadin and try and allay some of your concerns.

Before I discuss alternatives to Coumadin, let me tell you why this is the most frequently prescribed anticoagulant. In a nutshell, Coumadin has an unparalleled ability to thin the blood and prevent blood clots. More specifically, studies have shown that Coumadin can protect you from a stroke if you have:

  • Mechanical heart valves (their surfaces encourage blood platelets to stick to them).
  • Suffered an embolic stroke, one of three types of stroke caused by a fragment or clot of blood pumped from the heart to the brain.
  • Atrial fibrillation (AF), where atria fail to contract; blood forms pools and becomes sluggish.
  • Had an extensive heart attack (scar tissue weakens heart muscle tissue, which in turn weakens contraction of the left ventricle, possibly allowing blood to stagnate and clot).
  • Like any drug, Coumadin has side effects. Although the major one is excessive bleeding (bleeding gums, eye hemorrhages, blood in the urine and even a few bleeds in the brain), other rare reactions include weakness, cold sensations, itchy skin, fever and abdominal discomfort.

Indeed, blood thinning is a double-edged sword. While anticoagulants help prevent thrombotic and embolic strokes, I have to bear in mind that the risk of a stroke-induced hemorrhage is higher for those on Coumadin.

So now you can see why people trying to prevent blood clots struggle with this popular anticoagulant and often ask to trade it in for aspirin or other blood-thinning alternatives.

How Yolan Chose To Prevent Blood Clots

Yolan, 78, suffered with cardiovascular problems and, consequently, had a heart attack a few years ago. She began taking Coumadin but reported that she just didn’t feel right. Yolan experienced several unusual body sensations, which she attributed to the drug.

Against her doctor’s wishes, Yolan went off Coumadin and her symptoms abated. She now takes 324 mg of aspirin every other day (more about aspirin in a moment) and says she feels much better.

I’ve gotta tell you, folks, the decision to go off Coumadin can be a very difficult one; patients and their doctors often struggle together for the right answer. So let me offer some guidelines to help make this decision easier for you.

Coumadin is your best therapy—mandatory even—to prevent blood clots if you have mechanical heart valves. Studies show that it’s more effective than aspirin with other anti-platelet drugs. It should also be your first choice if you’ve suffered an embolic stroke.

Coumadin has been shown to protect patients with left ventricular clots and from AF, which can cause thrombotic strokes. Now, if you have AF, a common cardiac condition—you may wonder if you can take aspirin instead of Coumadin. If you have AF, your best bet is still Coumadin. If you’re not on conventional blood thinners like Coumadin, your risk of stroke is at least 5–6 times greater than those who are. This in itself is a disaster! In fact, approximately 75,000 strokes a year are attributed to AF.

Remember, with AF, the upper chambers of the heart may fail to empty completely, creating a perfect breeding ground for blood clots and poor blood circulation. As clots are formed and pumped out from the heart, they can wander around in the bloodstream until they find a vessel too small to get through and then you can have a major log jam in the brain, the leg, the kidney, in fact, anywhere at all. But the carotid artery is the number one spot to worry about because it’s a direct shot to the brain as the blood is pumped out of the left ventricle.

At least 90 percent of my AF patients take Coumadin; the other 10 percent take aspirin. But aspirin is less effective for preventing clots and strokes, particularly in women and people over 75. The best advice I can give anyone with more than two episodes of AF a year is to take Coumadin. If you have fewer episodes of AF and no other health problems like diabetes, congestive heart failure, leaking heart valves, or an enlarged heart, aspirin is a second choice.

For more information on how to prevent blood clots, visit www.drsinatra.com.
 

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