There is Still a Role for Warfarin
Blood thinners help prevent blood clots that can form in the legs and travel to the lungs, causing a potentially life-threatening pulmonary embolism, or that form in the heart due to the abnormal heart rhythm atrial fibrillation (these clots can travel to the brain, causing a stroke). The drugs don’t actually “thin the blood.” Rather, they prevent the body from producing clotting factors: proteins manufactured in the liver that are involved in the blood clotting process.
Several new blood thinners have become available in the last few years—but for many people, warfarin (Coumadin®), which was first approved in the U.S. in 1954, remains the best option.
Not Everyone Can Take Newer Blood Thinners Newer blood thinners include dabigatran (Pradaxa®), rivaroxaban (Xarelto®), apixaban (Eliquis®), and edoxaban (Savaysa®). But some people shouldn’t take the new blood thinners. For example, if you have a mechanical heart valve, or take blood thinners to manage atrial fibrillation due to a rheumatic heart valve, you shouldn’t take dabigatran, rivaroxaban, apixaban, or edoxaban. They also may not be safe if you have kidney or liver problems. Another issue to consider is the fact the new drugs cost a lot more than warfarin.
Risk of Bleeding All blood thinners increase the risk for excessive bleeding. However, there is evidence this is less likely to occur with the newer blood thinners and this means that people who take them need less monitoring. Conversely, people who take warfarin need regular blood tests that measure the time required for their blood to clot. Doctors use this information to adjust the drug’s dosage as necessary. “It is challenging to find the right dose, particularly in people who’ve just started using warfarin,” explains Judith Beizer, PharmD, clinical professor at St John’s University College of Pharmacy and Health Sciences. But once the correct dose is established, the drug is very effective.
While less monitoring may seem more convenient, it is important to keep in mind that dabigatran is currently the only new blood thinner that has an antidote to reverse excessive bleeding. If you bleed while taking warfarin, the drug’s effects can be reversed with a drug called phytonadione (a synthetic form of vitamin K), or with fresh frozen plasma (FFP), which contains clotting factors.
You should stay alert for signs of bleeding no matter which blood thinner you take. Don’t panic about slight bleeding from the gums after brushing your teeth, or the fact you may bruise more easily—but call your doctor or 911 if you have tarry or bloody bowel movements, if you vomit blood, have a continuous nosebleed or if a cut won’t stop bleeding. “Internal bleeding may not be obvious,” Beizer says, “so speak with your doctor if you start to feel lightheaded, winded, or more fatigued than usual while taking warfarin.”
Consistent Diet Important With Warfarin Warfarin blocks the action of vitamin K, which the liver needs to make clotting factors. Consuming too much vitamin K can decrease the effects of warfarin. But you don’t have to avoid foods that contain vitamin K (it’s found in in liver, peas, broccoli, dark green leafy vegetables, and soybeans). Instead, keep your consumption of these foods consistent, and if you eat more of them than usual let your doctor know. “Limit your alcohol consumption to no more than one drink a day, as it too can interact with warfarin,” Beizer adds. You should avoid vitamin E, and herbal supplements like ginkgo and garlic, as these also can increase the risk of bleeding—and don’t mix warfarin with NSAIDs, since this can increase bleeding if it occurs. “Don’t take any over-the-counter product without first speaking with the pharmacist or your doctor,” Beizer says.
Other Precautions Carry an ID card or wear a medical alert bracelet stating that you take warfarin, in case of emergency. “Medical personnel need to know, since warfarin interacts with many other drugs,” Beizer explains. Also tell your doctor or dentist that you’re taking warfarin before they prescribe other medications and before surgery.
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