Blood thinners are life-saving medications used to treat several conditions, but they are also dangerous drugs associated with many serious side effects. Anticoagulant therapy is often necessary to treat patients suffering from many severe conditions such as valvular-atrial fibrillation (Afib), pulmonary embolism (PE), venous thromboembolism (VTE), deep vein thrombosis (DVT), myocardial infarction. They’re also used as a preventive treatment in patients that have a high thromboembolic potential, like those who recently underwent lower limbs surgery, or were implanted with mechanical heart valve prostheses. The main purpose of these medications is to reduce the risk of dangerous blood clots forming in a patient’s body. If those thrombi do move to delicate organs such as the heart or brain, in fact, the patient could suffer a stroke, which could cause severe injuries or even death (1).
Although anticoagulation therapy is often mandatory in most high-risk patients, it should be noted how this kind of treatment still poses a significant risk because of its significant adverse effects, especially on elderly people. For example, just by looking the FDA medication guide of Xarelto (rivaroxaban), a very well-known Novel Oral Anticoagulant (NOAC) marketed by Janssen Pharmaceuticals and Bayer, the number of side effects is just astonishing. They range from nose and gum bleeding and heavier menstrual or vaginal bleeding to more worrisome ones such as pain, swelling, or new drainage at wound sites (2). Nonetheless, if those weren’t enough, other much more dangerous adverse reactions include gastrointestinal bleeding and life-threatening uncontrollable internal hemorrhages. This kind of accidents has been much more commonly associated with newer NOACs such as Xarelto or Pradaxa (dabigatran) than with older prescriptions (3).
Blood thinners: life-saving at a high-risk cost
Some anticoagulants like Coumadin (Warfarin) also require the patient to be strictly monitored by performing frequent blood testing to adjust the medication’s dosage properly, and to keep it within precisely defined safety ranges (4). Specific dietary restrictions are also required, because many foods containing high levels of Vitamin K such as avocado or spinach may interfere with its mechanism of action, thus reducing its efficacy. What is less known, though, is that many other foods and supplements may actually increase the effects of all anticoagulants (not just Warfarin), as they possess more or less significant blood-thinning properties. Some examples are bilberry, Ginkgo Biloba, pomegranate, red clover, cranberries, licorice but even much more common foods such as celery, garlic, onion or green tea that may possess blood-thinning effects if consumed in larger doses. Alcohol consumption can also be somewhat dangerous, especially in non-chronic, occasional drinkers (5). Ironically, drugs that require constant monitoring and more strict dietary routines often prove to be less dangerous to patients, due to the increased awareness and attention posed towards their safety requirements.
Other very common substances such as over-the-counter painkillers, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) can also increase the risk for major bleeding events. NSAIDs do possess inherent blood-thinning properties, and Aspirin is in fact listed among the possible anticoagulant treatments available. Although roughly 25% of NSAIDs-related bleeding accidents do happen within 8 days from the assumption, some bleeds occur with just a single dose. This risk is especially high in patients suffering from atrial fibrillation – which, on the other hand, is the primary indication for which the dangerous Xarelto is prescribed (6).
Another serious risk associated with anticoagulant therapy comes from its sudden discontinuation. Interruption of treatment may, in fact, prove to be fatal to patients, as it can significantly increase the risk of brain blood clots and strokes. Several patients showed an increase of up to +300% in the number of blood clots shortly after they stopped taking this medication (7). Just as many other Xarelto side effects, brain clots and strokes are a very serious issue since usually those medications are stopped shortly before a patient undergoes a surgical intervention, including minor ones such as orthodontic treatments or dental prosthetics implants. Nonetheless, recent studies suggested that continuous treatment with blood thinners before surgical interventions is not associated with an increase in surgical complications (8). Still, if on one hand discontinuation of these prescriptions may increase the risk of cerebral and cardiovascular complications, the probability of an uncontrollable bleeding accident still persists. A danger that’s even more significant with the NOACs. While all other anticoagulants and antiplatelet drugs action can be reversed thanks to the availability of specific treatment options, there’s still no NOAC antidote available to save the patient from bleeding to death (9). Patients undergoing this kind of long-term treatment should be properly informed of the danger of life-threatening bleeding events occurring during even the most simple surgical intervention.
What’s more alarming is that more and more patients every day receive NOACs such as Xarelto as first-line prescriptions, even if these medications should be treated with great care. A recent study showed that how about 25% of low-risk for stroke patients were prescribed blood thinners, contrary to current treatment guidelines. The general underestimation of NOACs dangers largely increased the number of people taking this drugs, consequently broadening the chance of potential injuries and accidents. Whether in patients presenting several risk factors the benefit of stroke reduction mostly outweighs the risk for bleeding events, the same cannot be said for low-risk patients, especially in those under 60 years of age (10).
Recent advertisement depicts NOACs as completely safe drugs that improve patient’s quality of life by freeing them from annoying habits, such as the need for continuous blood testing and the dietary restrictions. However, people should be more attentively warned of high-risk medications that can seriously endanger their lives. NOACs are not “safer” drugs, they’re as dangerous as their competitors are. Indeed, they’re probably even more dangerous than them, due to the fact that there’s no real way to save a patient’s life because of the absence of a proper antidote.
Article written by: Dr. Claudio Butticè, Pharm.D.
Last Updated: 2016/08/10