Nearly 900,000 Americans have DVT each year, and 60,000 to 100,000 die of a pulmonary embolism, according to the Centers for Disease Control and Prevention (CDC). Deep vein thrombosis is “mostly a disease of aging,” says Mary Cushman, MD, director of the University of Vermont Medical Center’s Thrombosis and Hemostasis Program, in Burlington. “Among women younger than 30, the annual risk is just 1 in 10,000. There’s a sharp increase around age 40 or 45, and by the time you’re in your eighties, your annual risk is 1 out of 100,” says Dr. Cushman. That’s because blood begins to clot more easily as you age, although researchers aren’t sure why, Cushman says. Pregnancy, taking estrogen-containing birth control, or using hormone therapy increases women’s chances of deep vein thrombosis, the CDC says. Serious illnesses, injuries, obesity, and long periods of inactivity can also increase your risk. The good news is that blood-thinning medications can stop clots from forming, slow their growth, or prevent clots that have already formed from wreaking havoc in other parts of the body. These drugs — which include warfarin, heparin, and newer medications such as apixaban and rivaroxaban — work in different ways, but all interfere with the clotting process. In the United States, two to three million people will need to take blood-thinning medications, according to the National Blood Clot Alliance (NBCA), in Rockville, Maryland. And while these drugs save lives, they can also cause side effects, from bruising to unwanted bleeding, notes the NBCA. As a result, there’s a lot you need to know when taking blood-thinning medications. Here are 16 dos and don’ts for staying safe and fully protected:
1. Do Watch Out for New or Increased Bleeding
“The main side effect of a blood thinner, not surprisingly, is bleeding,” says Christopher B. Granger, MD, a cardiologist at Duke Health in Durham, North Carolina. The reason is that blood thinners are preventing your body’s natural ability to clot blood, which it does to stop bleeding or minor wounds. So when taking a blood thinner, you might notice increased bleeding from cuts or scrapes, more frequent or more intense nosebleeds, or heavier-than-normal periods. But this is no cause for alarm, says Dr. Granger. For most people who have to take blood thinners, the benefit will outweigh the risks. If minor bleeding bothers you, don’t stop taking the medication, Cushman says. Ask your doctor or pharmacist to recommend special wound dressings and other over-the-counter products that can help. But if you notice blood in your urine, begin coughing up blood, vomit material that looks like coffee grounds (an indication of bleeding in the stomach), or have black bowel movements (a possible sign of bleeding in the digestive tract), call your doctor immediately, Cushman says.
2. Do Have Your Blood Checked as Often as Your Doctor Recommends
“Warfarin requires regular blood work to ensure you have the right dose, so your blood doesn’t become too thin or not thin enough,” says Cushman. “At the beginning, it can be two or three times per week. Once you’re stabilized, it’s usually every four weeks or so.” Some of the newer drugs, which work on more closely targeted aspects of the clotting process, don’t require as much testing because they cause less bleeding, says Granger. “This is one of the reasons that we’re particularly enthusiastic about some of the newer blood thinners called DOACS,” notes Granger about direct oral anticoagulants like apixaban and rivaroxaban. “Compared to warfarin, the old-fashioned blood thinner, DOACS caused less bleeding into the brain, which is the most devastating type of bleeding.”
3. Do Tell Your Healthcare Provider About Any Other Medications You Take
Let your doctor, nurse, or pharmacist know about any prescription or over-the counter drugs, vitamins, and herbal supplements you’re taking. Some drugs and supplements can affect the results of the test used to monitor blood-thinner levels, the NBCA reports. Granger warns against taking aspirin and nonsteroidal drugs like naproxen and ibuprofen that can increase your risk of bleeding. A study published in March 2019 in JAMA Internal Medicine found that out of 3,688 people on the blood thinner warfarin, the 37.5 percent who were taking aspirin had higher rates of bleeding, visits to the ER, and hospitalizations due to bleeding. Some drugs should be avoided unless there is a clear reason for taking them like clopidogrel, ticagrelor, or prasugrel, which help reduce the risk of stroke. Other drugs, such as amiodarone, which controls heart rhythm, double in potency when the patient is also taking warafin. Diflucan, used to treat yeast infections, and ciprofloxacin, an antibiotic, can increase warfarin’s anticoagulant effect, while the epilepsy drug phenytoin can decrease it, according to the NBCA. Herbal supplements, such as garlic or ginkgo biloba, may also increase your bleeding risk, the organization says.
4. Do Tell Your Doctor if You Plan on Stopping Any Medication
Just as taking prescription and over-the-counter drugs can affect your blood-thinning medication, so can stopping them. If you discontinue any of them, your doctor may want to check your blood more frequently, the NBCA advises.
5. Do Talk to Your Doctor About Different Dosages
Granger says that typically warfarin blood thinners are started on a lower dose and increased as necessary, as higher doses also increase the chance of excessive bleeding. “Most people who are either very elderly or who have decreased renal function and decreased kidney function may be most appropriate to be on a lower dose,” says Granger. “Being on the correct dose is important.” Even with the new DOACS, dosage may need to be changed depending on other medication you may be taking, such as apixaban, rivaroxaban, and edoxaban, according to a guide published in June 2020 in the Journal of the American Heart Association. If you think your dose is incorrect, talk to your doctor about adjusting your medication.
6. Do Consider Wearing a Medical Bracelet
In case of an emergency — such as a car accident — it’s important that healthcare providers know you’re taking a blood thinner, which can raise your bleeding risk and potentially change your recommended treatment. Wear a medical-alert bracelet, available in some pharmacies and online, or carry a card in your wallet that states the name of your blood thinner, the Cleveland Clinic advises. New devices like the Apple Watch and Fitbit have apps that can check your heartbeat and rhythm for atrial fibrillation, which can be a sign of blood clotting. If a device identifies possible irregular heartbeats, schedule an appointment with your physician.
7. Do Plan Ahead for Travel
If you plan on taking a trip, get your doctor’s okay for traveling, advises Michael Zimring, MD, director of the Center for Wilderness and Travel Medicine at Mercy Medical Center in Baltimore. Then research your destination: Learn where the nearest hospital or clinic is in case you run into a situation that causes excess bleeding or in need of emergency blood work.
8. Don’t Sit Too Long While Traveling
Car or plane trips can raise DVT risk, because you’re inactive for long periods of time. Taking a blood thinner makes it less likely that you’ll get a clot, but “it’s still smart to get up and move around every hour or two,” Dr. Zimring says. What if you’re stuck in your seat for a while? “Lift your legs up down, pump your calves, point and flex your toes — do anything you can to get the blood flowing,” he says.
9. Don’t Stop Eating Green Veggies
Warfarin works by reducing the clotting effects of vitamin K, which is found in many green vegetables, including kale, broccoli, Brussels sprouts, and collard and mustard greens. So if that’s the medication you’re taking, eating too many of these foods at once could reduce its effectiveness, Cushman notes. But if you eat moderate amounts of green vegetables every day, your doctor can take that into account when determining the dosage you need, she adds. “If you binge on a big spinach salad one day, you might have problems,” Cushman says. “But if you eat salad every day and don’t vary it, you’ll be stable. You don’t have to totally block [these foods] out.”
10. Do Drink Plenty of Water While Taveling
Dehydration causes blood vessels to narrow and blood to thicken, raising the risk for blood clots. So staying well-hydrated improves circulation, according to the American Heart Association. What’s more, having a full bladder will prompt you to get up regularly to use the restroom, helping prevent long periods of sitting, Zimring adds.
11. Do Seek Care Immediately if You Have a Major Fall
Call your doctor or go straight to the emergency room, advises the government-sponsored U.S. Agency for Healthcare Research and Quality (AHRQ). Even if you aren’t visibly injured, you could be bleeding internally, especially if you hit your head, the AHRQ notes. And a bruise is a sign that you’re bleeding beneath the skin. But Granger says the risk of falling is not high enough that patients should steer away from blood thinners, especially newer drugs. “People who have atrial fibrillation and fall still have a greater benefit than risk to take the anticoagulant, especially DOACS, where the risk of intracranial hemorrhage [bleeding inside the skull] is much lower than with warfarin,” she says. The only exception is for people who fall and hit their head hard and maybe get a subdural hematoma, when a blood vessel between the brain and the skull is damaged, then that’s a reason not to take a blood thinner, Granger adds.
12. Don’t Worry Too Much About Shaving
People on blood thinners are often fearful of cutting themselves while shaving, but “you won’t bleed to death from a nick,” Cushman says. If shaving any part of your body stresses you out, switch to an electric razor or a different hair-removal method.
13. Don’t Drink Excessive Amounts of Alcohol
Enjoying a glass or two of wine or beer shouldn’t be a problem. But if you take warfarin, excessive amounts of alcohol can alter how the drug is metabolized and raise your bleeding risk, cautions Cushman. Drinking too much also increases your chances of falling or having an accident, she adds.
14. Don’t Necessarily Stop Your Blood Thinner Before a Dental Procedure
Dental treatments can cause bleeding, which may last longer if you’re taking a blood thinner, the American Dental Association (ADA) notes. So let your dentist know what drug you’re taking. But that doesn’t mean you should stop or reduce the medication before a procedure. The risks of doing so “far outweigh the consequences of prolonged bleeding, which can be controlled,” the ADA says.
15. Don’t Double Up on Missed Doses
You should try to take your blood thinner at the same time each day, in accordance with your doctor or pharmacist’s instructions. But if you forget a dose, resist the urge to make up for it with a double dose next time. Instead, take the missed dose as soon as you remember and call your doctor for advice on your next step, the Cleveland Clinic recommends.
16. Don’t Be Afraid to Stay Active
Staying physically active is healthy, so don’t stop your favorite exercise routines because you’re using blood thinners. “Not only can you, but you should stay active,” says Granger. “Now, I wouldn’t do anything crazy like jumping out of airplanes or getting into a boxing ring, but most things are okay.” But do take the proper precautions, the NBCA notes. Always wear a helmet when cycling or skiing, proper shoes when hiking (to avoid cuts), and gloves when gardening. And wear your bracelet or carry your blood thinner card in case of an injury. Low-impact activities such as walking, biking, yoga, Pilates and strength training are all fine. But if you enjoy higher-risk sports, ask your doctor if they’re safe for you, the NBCA advises.
