Mar 17, 20215 min read

What Are Your Thoughts On Taking Blood Thinners??

Shout out to Debbie for this question!

So…a topic that was presented to The Rollin’ RNs involves taking blood thinners. One of our readers wanted our thoughts about how long she should stay on her blood thinner prescribed to treat a blood clot.

That’s a great question worth digging into but ultimately this is a question that needs to be discussed with your doctor. It’s a very important and individualized decision that will depend on some key factors such as:

The location of the blood clot
Why the clot formed (what risk factors contributed to your clot)
An assessment of your risk for developing future clots if your blood thinner is stopped (what risk factors you have which may cause a clot recurrence)
How you have tolerated the blood thinner and what your risk for bleeding is if you stay on a blood thinner.
Are you still having frequent blood levels drawn per your physician’s orders?

Lets start with a little background on blood clots

Blood clotting is a normal, complex process that prevents excessive bleeding when a blood vessel is injured. Sometimes, clots form abnormally within a blood vessel and can occur in both arteries and veins.

Blood clots, which form in veins, are very different from clots, which occur in arteries. Arteries are the blood vessels that carry blood away from the heart to your extremities (legs, arms, abdomen, brain). Think A for Away!! While veins are the blood vessels that carry blood back to the heart from the extremities.

Blood clots, which form in arteries, may lead to stroke, transient ischemic attacks (TIAs or mini strokes), and heart attacks because they lead from the heart. Stop and let that sink in!

When a clot forms in the deep veins of the body, it is called deep vein thrombosis (DVT). DVTs occur most commonly in the leg; however, it can occur anywhere in the body, such as the veins in the arm, abdomen, pelvis, or around the brain. A potentially life-threatening complication of deep vein thrombosis (DVT) is pulmonary embolism (PE). A PE occurs when a blood clot breaks off from a DVT and travels through the blood stream and lodges in the lung. Occasionally, a PE can form in the lung itself. Clots that break off from a DVT and travel do not typically lead to stroke, as they get filtered out by the lung. We are not here to frighten you, but just to make you aware of these potential nasty complications.

The following factors increase your risk of developing a blood clot:

· Obesity

· Pregnancy

· Immobility

· Smoking

· Inactivity (long trips by plane or car)

· Oral contraceptives

· Certain cancers

· Trauma

· Certain surgeries

· Age (increased risk for people over age 60)

· A family history of blood clots

· Chronic inflammatory diseases

· Diabetes

· High blood pressure

· High cholesterol

· Prior central line placement

Treating Blood Clots

Your doctor will give you medicine that makes your blood slower to clot. These drugs, called anticoagulants or blood thinners can keep a DVT from getting bigger while your body breaks it down. They can also help keep another clot from forming. Some are given as shots, and some are pills.

It usually takes about 3 months to treat a DVT. If you aren’t likely to have another one, you may be able to stop taking your blood thinner. People at higher risk may need to stay on them for years, possibly life. That’s why it’s so important to talk with your doctor about what’s best for you.

Your treatment plan will be different depending on which medication you take. For decades, Warfarin has been the go-to drug for treating a DVT. It can take a few tries to get the dose right, and it may need to be changed from time to time, so you’ll get your blood tested often -- maybe two or three times a week at the beginning of treatment. Later, you may only go in once a month.

The things you eat and drink and the drugs and supplements you take can affect the way Warfarin works, so you may need to make some lifestyle changes. For example, Vitamin K helps your body form blood clots (think K for Klotting!), and foods that have a lot of it may keep blood thinners from working as well as they should. That means you may need to limit things like green leafy vegetables, fish, and other foods high in Vitamin K.

The newer kid on the block medicine is a class of blood thinners that doesn’t require frequent blood testing while taking them and you don’t have to be as careful with food or other medications. These can include drugs like Eliquis, Pradaxa, and Xarelto.

A downside to taking blood thinners is that they can put you at risk for uncontrolled bleeding so keep an eye out for these signs:

Easy bruising
Nosebleeds
Intense headache
Stroke symptoms like confusion, weakness, or slurred speech
Throwing up blood
Blood in your urine or stool
Unusually heavy vaginal bleeding
Low blood pressure symptoms like weakness, dizziness and shortness of breath

In addition to taking your medication as instructed by your doctor, you can do a few other things to make another DVT less likely:

Get up and around as soon as you safely can after an injury or surgery. Just getting out of bed and into your wheelchair moves blood through your system. (You’ll see this in action in the hospital setting when the nurse has their patient sitting up and dangling their legs on the side of the bed or even walking around as early as the same day or day after a procedure.)
Try not to sit for more than a couple of hours at a time. Along with your frequent pressure reliefs, if you can, manually pick your legs off your footplate one at a time and move them around or massage them to promote blood circulation. (However, DO NOT massage any area if you suspect a DVT* or you’re recovering from one.)
On long trips, wear compression stocking to keep blood from pooling in your lower legs.
Stay a healthy weight.
Don’t smoke.
Drink plenty of water.
Let all your doctors know you’ve had a DVT or are taking blood thinners, including your dentist.
Wear compression stockings and elevate legs to keep blood from pooling in your lower legs.
Exercise regularly to get blood moving through your system.

Remember, it usually takes about 3 months to treat a DVT. If you aren’t likely to have another one, you may be able to stop taking your blood thinner. However, people at higher risk may need to stay on them for years, possibly life.

So that’s a lot of information we’ve thrown at you. We hope it gives all of you a little more insight on blood clots, risk factors, treatments and prevention. Talk with your doctor about your situation and together you can come up with a plan individualized for you.