When do you need blood thinners?

A postmortem carried out on General Paul Lokech’s body revealed that he had a blood clot in the lungs after fracturing his ankle. There are many people who develop blood clots from injuries, surgeries and many other causes and sadly, if not well monitored such people die yet they can be put on blood thinners.

Blood thinners are scientifically referred to as anticoagulants. 

Blood is supposed to keep flowing through the circulatory system and when blood clots, it becomes thick, causing blockage in the vessels according to Dr Henry Ddungu, a haematologist at Mulago Hospital.

Naturally, blood should not form clots. When you get an injury, there is a way blood is controlled to remain in a stable state. When this does not happen, one can develop clots.

He says, “When blood attempts to leak out of the vessel, a clotting system (thickening) is triggered in the body. A number of factors are at play starting with the lining of the membrane in the vessel, the platelets and the protein and enzymes (clotting factors) come in as a way of rescuing the situation thereby forming a blood clot.”

The blood should not remain in a clotting state. The body usually finds a way of maintaining blood in a state that enables it to move freely through the vessels. When this does not happen, it is the reason you need the anticoagulants (blood thinners).

Besides injuries, some people’s blood clots very frequently because of health conditions like pregnancy, obesity, immobility, trauma and recent surgeries. 

Blood thinners therefore, are medications that help stop blood from thickening (forming clots) and these include Vitamin K antagonists, direct oral anticoagulants and heparin. 

It should be noted that anti-platelets like aspirin are not entirely blood thinners but since platelets play a critical role in clotting some people may refer to them as blood thinners.

The anti-platelets lower the blood’s ability to form clots by preventing platelet cells from sticking together and forming clots. 

“They stop the platelets from being activated to initiate the clotting process. This is the reason why people who are on aspirin take longer to stop bleeding when they get injured,” Dr Ddungu says. 

Among anticoagulants are clot busters that help split a clot into smaller particles to help open up a clogged vessel. 

The most commonly used anticoagulant is warfarin which is a vitamin K antagonist. 

It is used to develop a number of other blood thinners.

The direct oral anticoagulant which work faster than warfarin and are more predictable since you may need the same dose for every person.

Low molecular weight heparin which is used as a bridge for long term use of oral anticoagulants. At some point one may need to take both for a while as the doctor closely monitors how you are reacting to the medication. Once your blood levels are high enough, the heparin is stopped.

Who needs them?

People who have developed blood clots in the big vessels in the veins or arteries need blood thinners and how long they should take them depends on the prescription of the specialist that is handling them.

“You are at risk of developing blood clots in the chambers of the heart if you suffer from a heart condition where the rhythm is not regular and beats in an uncoordinated way (atrial fibrillation). Once the clots form, when the heart pumps, clots can be moved to the arteries of the brain thereby getting a stroke,” Dr Ddungu says. He advises such people to use anticoagulants.

You also need anticoagulant treatment if you suffer from deep vein blood clots. On the other hand, someone who has had a heart attack after treatment and resuscitation of their health should be maintained with anti-platelets.

In sickle cell patients, it is not because  blood is clotting that they take the aspirin, according to Dr Ddungu, but because of the nature of the haemoglobin in the red blood cells. When there is lack of enough oxygen, the cells are not able to go through the arteries so they get stuck thereby mechanically blocking the vessel which might then  lead to a crisis. 

The anti-platelet in this case will help to reduce the incident of stroke when the cells block the vessels.

The limitations

It should be noted that blood thinners should only be prescribed by qualified personnel. You are at risk of bleeding to death if you take blood thinners without instructions from the doctor. 

The doctors will also help tell you whether you need to stay on the anticoagulants for the rest of your life or just for a while.

The doctor will not recommend blood thinners for a person who is bleeding both physically and internally because one will not stop bleeding irrespective of where the bleed is happening.

Dr Ddungu says, “Some people are allergic to the components in the blood thinners. Also, patients with impaired kidney function need to be monitored by their healthcare professional and have their dose adjusted as necessary.”

If you are taking blood thinners, inform your doctor about any other medications that you are taking to help him assess the best combination for you. 

You must see your doctor if you develop the following;  Severe bleeding that does not stop easily,  vomiting or coughing blood and bloody urine. Other signs to look out for are unusual bleeding from gums, frequent nosebleeds and heavier than usual menstrual bleeding. 

Blood thinners dos and don’ts 

If you’re at risk of deep vein thrombosis (DVT), you’re probably taking blood-thinning medication to prevent clots. Do you know how to use anticoagulant drugs safely and effectively?

Blood clots are a serious issue. If a clot forms inside a large, deep vein, typically in the leg – a condition called deep vein thrombosis (DVT) – it could break free and travel to the lungs. There, it can cause a life-threatening blockage known as a pulmonary embolism.

Do watch out for new or increased bleeding: 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.

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. 

Do tell your caregiver 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.

Do tell your doctor before stopping any medication.: Just as taking prescription and over-the-counter drugs can affect your blood-thinning medication, so can stopping them.

Don’t stop eating green vegetables.

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 green.

Do drink plenty of water while traveling:  Dehydration causes blood vessels to narrow and blood to thicken, raising the risk for blood clots.

Don’t worry too much about shaving: Patients on blood thinners are often fearful of cutting themselves while shaving, but “you won’t bleed to death from a nick,

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,

Don’t stop your blood thinners before a dental procedure: Dental treatments can cause bleeding, which may last longer if you’re taking a blood thinner,

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

Don’t be afraid to stay active: Regular physical activity is healthy, so don’t stop your favourite exercise routines because you’re using blood thinners.

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