Some of the most challenging medical problems we face have to do with the formation of blood clots. For instance, clots can create heart attacks and can cause lack of blood flow to the extremities, resulting in loss of fingers, toes, arms or legs. Clots — when lodged in large blood vessels in the lungs — produce chest pain, difficulty breathing, or even death from what we call a pulmonary embolism. Despite their relatively small size, clots in the brain can produce a type of stroke.
People who live with atrial fibrillation — an irregular heart rhythm — can form clots in the atrium of the heart, which can then move out into the circulation and cause some of the complications above.
For this reason, many individuals take potent blood thinners, or anticoagulants. For years, we had (and still have) the old standby known as Coumadin — or the generic, warfarin — which patients took daily. This is a great blood thinner, and its effects can be reversed with certain medications in cases of dangerous bleeding.
More and more, we see the use of other drugs — like Eliquis, Xarelto or Pradaxa — which are very potent and do much the same thing as warfarin. However (and this is a selling point), they do not require routine labs as warfarin does.
Of course, every medicine has its problems. The newer anticoagulants can be harder to reverse in cases of bleeding. Nevertheless, they can make a huge difference in the lives of those who depend on them to prevent dangerous clots after stroke, heart attack, heart valve replacement, or any other indication for which they are used.
While physicians sometimes darkly joke that “all bleeding stops,” the other fact about blood thinners is that the bleeding that can result from their use is sometimes dangerous. Bleeding from stomach ulcers or colon polyps, from nosebleeds, or even minor trauma can be dramatic when it occurs in a patient who is taking an anticoagulant.
It is very important for patients to keep a list of medications handy and mention any anticoagulant they’re taking when they see a physician. Many older patients don’t know their medications in detail. This is no surprise — since, for better or worse, Americans take so many medications. Therefore, it is vital for friends and family of seniors to also have access to the medication lists of older loved ones and then share those prescription lists with physicians whenever their family members interact with the health care system.
Modern medicines prolong life and significantly improve its quality. But they require caution and diligence. Bleeding may stop eventually, but all physicians (and patients) would like it to stop sooner rather than later.