For people with heart disease, blood vessel diseases or poor circulation, blood-thinning medications can be a life saver. According to the National Blood Clot Alliance, 2 to 3 million Americans are prescribed blood thinners to help prevent clots from forming in the blood and reduce a person’s risk of heart attack and stroke. However, these drugs have some side effects and lifestyle implications that caregivers should be aware of.
Two Types of Blood Thinner Medications
- Anticoagulants are the most common that your loved one may be on. A popular one is warfarin, which goes by the brand names Coumadin and Jantoven and is administered in pill form. Popular alternatives to warfarin include dabigatran (Pradaxa), rivaroxiban (Xarelto) and apixaban (Eliquis). Heparin (brand names Clexane and Lovenox) is another commonly prescribed option, although it is injected rather than taken orally. These drugs are aggressive treatments for patients with atrial fibrillation (a dangerous type of arrhythmia also known as AF, or AFib) or those who are at a high risk for stroke.
- Anti-platelet drugs are another option for patients, which are considered less aggressive treatments for patients prone to thrombosis or thromboembolism due to conditions like angina, peripheral artery disease (PAD) and recovery from recent heart surgery. Examples include aspirin therapy and clopidogrel (Plavix).
Although anticoagulants and anti-platelet medications employ different mechanisms to prevent blood clots and ensuing cardiovascular and cerebrovascular events, they both pose risks for increased bleeding. Your loved one’s doctor will determine which one is the best fit for their condition. Although there may be some similarities between these two treatment options (such as the need to avoid injury and bleeding), this article addresses restrictions and suggestions for caring for a loved one who is specifically taking an anticoagulant drug.
Is Their Blood Thinner Working?
Getting used to taking one of these drugs can take some time for both the patient and their caregiver. One of the most notable side effects is excessive bleeding. Patients sometimes experience "nuisance" bleeding that will not stop, like nose bleeds. Injuries that would be considered minor for most people may bruise or bleed excessively for people on anticoagulants.
To make sure this medication is working and the correct dosage is being administered, your loved one's doctor will prescribe regular Prothombin Time (PT) blood tests to measure how long it takes their blood to clot. This test can also find the cause of abnormal bleeding or bruising and check their liver function.
PT results are reported as an International Normalized Ratio (INR). The normal range for people who are not taking blood thinners is about 0.9 to 1.1. Someone who is receiving anticoagulation therapy should have results between 2 and 3.5 if their medicine is working correctly. The higher a patient’s INR is, the longer it takes their blood to clot and the higher their risk for bleeding is. However, if their INR is too low, it increases their risk of suffering a dangerous clotting event. An INR of 5 or more is considered dangerous. If your loved one’s numbers are outside of the above targeted ranges, it could be due to a bleeding disorder or reduced liver function, or it could simply indicate that lifestyle changes and/or alterations to their prescription are needed.
The frequency that PT tests should be taken is determined by your family member's doctor. If their insurance company covers the medical equipment and expenses, or they meet certain Medicare eligibility requirements, they may be able to administer the test at home with a point-of-care (POC) device. These devices use a simple finger prick (like a blood glucose test for diabetics) to obtain a small blood sample for testing. Patients who test at home usually need to test more often (up to once a week) than those who go to a lab or doctor's office since less expense and time are involved. This option may be best for a loved one who has mobility issues, but must closely monitor their INR. A person whose health and blood tests have been stable for some time typically only need to have a PT test done once a month.
Diet and Blood Thinners
Blood thinners can pose challenges for both the patient and their caregiver when it comes to making wise dietary choices. Many family caregivers grocery shop and prepare meals for their loved ones. It can be difficult to provide healthy meals that love ones will eat even without added dietary restrictions, but it is very important for a loved one on anticoagulant medication to stick to a consistent diet.
The biggest concern for these patients is the consumption of vitamin K, which is known as the “clotting vitamin.” Consuming too much of this nutrient can interfere with how anticoagulants work. Men are recommended to get 120 micrograms (mcg) of the vitamin per day and women should aim for 90 mcg. Some very healthy foods, like broccoli, kale, Brussels sprouts and spinach, are high in vitamin K, but caregivers should help their loved one monitor their intake. The goal is to keep their consumption fairly consistent from week to week to prevent any significant fluctuations that could interfere with their anticoagulation therapy. Many nutritional drinks and meal replacement shakes and bars such as Ensure or BOOST contain vitamin K, so keep an eye on the use of these products as well.
Online sources that show how much vitamin K is in various serving sizes of certain ingredients can be helpful. If you are struggling for meal ideas, digital cookbooks can help you find recipes that will not interfere with your loved one’s medications. Depending on the complexity of their dietary requirements and limitations, a dietician or a registered nutritionist can provide further support.
Alcohol can also affect the performance of these medications. If your loved one has a drink now and then, it should not be a cause for concern. Consistency in moderation is just as important for alcohol consumption as it is for food. Overindulging should be definitely be avoided, though, since alcohol has blood thinning or anti-platelet effects.
Foods are not the only items that can have negative interactions with blood thinning medications. Multivitamins, supplements, antibiotics and over-the-counter (OTC) medications can interfere with the blood’s clotting abilities, too. Salicylates are one of the most common culprits. This class of drugs includes nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (e.g. Advil, Aleve, Excedrin, Motrin), which can be found in medications other than pain relievers. For example, many types of cold medicine and even some digestion medications like Pepto-Bismol contain NSAIDs.
These over-the-counter drugs are easily accessible and common go-tos for the masses, but they can have serious effects on someone who is on a prescription like warfarin. This is why it is important to talk with the doctor or pharmacist before using any medications, vitamins or supplements they did not prescribe or preapprove. If you have any questions about whether something is safe or will have an effect on your loved one’s INR, call their physician or pharmacist.
Measures to Prevent Injury
Taking these drugs means your loved one needs to avoid activities and hazards that could cause bleeding. Accidents do happen, though, so it is a good idea to take proper precautions and preventive measures. This can be done by taking over risky tasks yourself or adapting them to be less dangerous.
Adaptation solutions to maintain a level of independence
- Making their living environment as safe as possible by organizing the home and arranging furniture in a way that reduces their risk of falls. (Certain products and home modifications can also help prevent accidents.)
- Having them switch to an electric razor, which can reduce the incidence of nicks and cuts.
- Insisting they use proper protection during activities. Have them wear gardening gloves while working in the yard and a cut-resistant mesh glove while they are using knives, graters, mandolins and other sharp tools to prepare meals in the kitchen.
- Switching to a soft-bristled toothbrush to reduce gum irritation and bleeding, and using waxed floss instead of things like toothpicks.
- Always wearing good-fitting shoes with non-skid soles both inside and outside the home.
If your loved one needs to have surgery or dental procedures done, make sure their surgeon or dentist knows they are taking an antithrombotic medication. They may need to stop taking their medication for a certain period of time prior to the scheduled procedure.
When to Seek Medical Help
If your loved one falls or hits their head, go to the hospital or call their doctor immediately, even if they are not visibly bleeding. Internal bleeding can occur, which can be deadly.
Indicators that medical intervention is necessary
- Red or brown urine
- Red or black stools
- Red or black vomit
- Prolonged bleeding from the gums
- Severe headache or stomach ache
- Unusual bruising
- A cut that won't stop bleeding
Supplies to Have on Hand
Your loved one may have incidents of bleeding that are not serious enough to warrant a trip to the hospital, so there are some medical supplies you will want to have on hand. Make sure you have a few special bandages and dressings formulated to control bleeding on hand. These can be bought without a prescription and applied to small cuts or scratches. There are also gel products that form a protective cover over cuts to stop bleeding and powders that create an instant scab when poured onto a wound. Similar items can be used to stop stubborn nose bleeds as well. Not only does this keep your loved one from unnecessarily losing blood, it can also help to keep clothing, linens and furniture clean and stain-free.
The ideal plan is to prevent bleeding in the first place, though. As always, it will take time and effort on your part as a caregiver to keep your loved one healthy and safe, but any action you can take to lessen their chance injury and bleeding could prevent an emergency.