By Dr. Peter Francis, M.D., M.B.A. (Medical Director at Gainesville Health & Rehab Center)
Our blood flows through a complex network of blood vessels called arteries, veins, and capillaries countless times per day in order to fuel our major organs with nutrients and oxygen. Over the course of a lifetime, these blood vessels can become narrowed as a result of many different types of diseases. Moreover, the blood clotting proteins, which normally serve the function of stanching the bleeding, from cuts, scrapes, and lacerations of all sizes, are activated all of the time as if in a heightened sense of readiness. Combine these two factors, aging and the inherent tendency for the blood to clot, and it is no surprise that blood clots may occur just about anywhere as we get older. This likelihood can be compounded by a variety of circumstances such as major surgery, hip fracture, sedentary lifestyle, cancer, and a whole host of others.
Blood clots, when they become clinically manifest or significant, require treatment with drug therapies called anticoagulants or blood thinners. Some examples of these include timehonored medicines called heparin and warfarin, also known as Coumadin. These drugs must be balanced along a fine line – benefit in terms of clot resolution on the one hand, while not thinning the blood excessively on the other. While these medicines are effective, widely available, and are well known to all physicians and health care providers, monitoring of blood thinners is not easy and there is a great deal of variability from one patient to another. Bleeding episodes are unfortunately seen with some frequency with both of these medicines, which may require specific antidotes.
In recent years, a whole spate of newer blood thinners that don’t require ongoing blood test monitoring have become available. First among these was enoxaparin, or Lovenox, an injection given under the skin once or twice per day.
More recently, oral drugs like Pradaxa, Xarelto, and Eliquis are starting to be used by clinicians to treat blood clots but also to prevent them from forming in patients with atrial fibrillation or who have undergone major hip and knee
surgery. These newer treatment options do not require blood tests like the PT/INR test used for Coumadin or the PTT for heparin because the doses are standardized by diagnosis, not by body size or build.
These newer medications share in common the same risk of unwanted bleeding as their predecessors and the severity can vary from minor bruises to severe internal bleeding. Please consult your health care provider here
at the facility or externally to determine which of these blood thinners is the best option for patients with blood clots and especially if you sustain a fall or injury of any kind while taking one. This is especially important for seniors as
the symptoms of bleeding within the extremities, abdomen or brain may often be subtle and delayed compared to younger patients.
All in all, though, these medicines do serve a valuable role of helping to prevent against or treat established blood clots. They vary in how they work and the newer ones are quite pricey but appear to be more effective and convenient than heparin and Coumadin. You and your loved ones should always mention to your health care provider that you are taking blood thinners. Also, wearing a Medic Alert bracelet reminding all of this reality is a wise decision.
