Latest news with #anticoagulants
Medscape
01-08-2025
- Health
- Medscape
PCPs Guide to Prescribing Blood Thinners for AF
As a primary care physician (PCP), you're often the first healthcare professional that will identify cardiac issues, including atrial fibrillation (AF). Individuals with AF face a fivefold risk for stroke. Therefore, these patients are often prescribed blood-thinning medications (anticoagulants) to slow blood clotting, according to the American Society of Hematology (ASH). Up to six million Americans have AF, the risk for which increases with age. The ASH says there are 450,000 hospitalizations each year because of AF. It's very important to check on your patient's response within the first few months of taking blood thinners. In fact, patients with AF who took low doses of oral anticoagulants experienced a higher incidence of bleeding episodes during the first 3 months of treatment, according to a study published in Blood Advances . When Should PCPs Prescribe Anticoagulants? PCPs should consider prescribing oral anticoagulants when they are the principal caregivers for patients with AF, acute deep venous thrombosis, or acute pulmonary embolism, according to R. Michael Benitez, MD, a cardiologist at the University of Maryland Medical Center and a professor of medicine in the Division of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore. The decision to prescribe an oral anticoagulant must be based upon the patient's risk without anticoagulation weighed in context with the patient's risk for significant bleeding, he said. How Can Physicians Best Communicate the Rationale for Anticoagulant Therapy? When describing AF, PCPs can explain to patients that the upper chamber of heart is 'wiggling' and not effectively contracting and when blood is not being effectively moved forward, it tends to clot, said Benitez. Physicians can also share that a clot as small as 2 mm is large enough to cause a major stroke if it were to break loose from the inside of the top chamber and be pumped with the blood to the brain, suggested the cardiologist. 'The oral anticoagulant greatly reduces the risk of the formation of these blood clots and subsequent stroke,' Benitez said. 'Stroke is a terrible event that, if survived, often changes a patient's life permanently and significantly. In the setting of atrial fibrillation, anticoagulation greatly reduces the patient's risk of stroke.' Regarding deep venous thrombosis, physicians can explain that a blood clot in the leg veins could break loose and be pumped through the right side of the heart to the lungs. 'This event, pulmonary embolism, can cause critical illness or even death; the risk can be greatly reduced through the use of oral anticoagulants,' said Benitez. What Are Important Directives Regarding Usage? PCPs should stress that daily use is critical to the success of the drug in preventing stroke. 'In the case of the new direct oral anticoagulants, such as apixaban or rivaroxaban, the drugs both work very quickly but also wear off very quickly,' said Benitez. 'This means that even missing just 2-3 days is enough for the blood to again clot normally. It is essential that the drugs be taken daily to prevent stroke.' In the case of warfarin, the effect of the drug is more prolonged. While missing a single dose is unlikely to markedly change the degree of anticoagulation, it's still best to remind patients not to miss doses and take this daily as prescribed, according to Benitez. What Side Effects Should Be Discussed? It is extremely important with warfarin — and to a lesser degree with direct oral anticoagulants — to always make certain that there is no drug-drug interaction that might affect the degree of anticoagulation when new medications are introduced, such as antibiotics, said Benitez. Other side effects to bring to a patients' attention are minor bleeding (such as gum bleeding with dental flossing) or nose bleeds that stop easily, which don't require immediate medical attention. However, your patients should self-monitor bleeding episodes and know a course of action if injured. 'If bleeding will not readily stop then medical attention is needed, and patients who incur major injury or trauma are likely to be taken to an emergency facility where it is important for the staff caring for them to know what anticoagulant they are taking, the dose, and when they last took it,' Benitez said. 'Reversal agents are now available to normalize blood clotting.' Your patients may be concerned with food that could interact with these medications. Benitez said there are no significant food interactions or dietary restrictions. But when prescribing warfarin, some nutritional guidance is warranted. 'With warfarin, which is a vitamin K antagonist, it is essential that the patient limit their intake of food containing vitamin K, as it is essentially an antidote or reversal agent for the anticoagulant,' he said. Some sources of vitamin K are well-known, such as leafy vegetables like spinach, kale, and other greens. However, there are many other dietary sources rich in vitamin K that may not be as obvious, such as cauliflower and soy products, Benitez said. 'It is important for the patient to familiarize themselves with vitamin K-containing foods and to keep the intake of them low and steady from day to day if they are taking warfarin,' he said.
Health Line
28-05-2025
- General
- Health Line
Ulcerative Colitis (UC) and Blood Clots: Can Anticoagulant Medications Help?
UC may increase your likelihood of forming a blood clot. Talk with your doctor about the potential risks and benefits of anticoagulant medications. Some people with ulcerative colitis experience hypercoagulability, which means their risk for blood clots is increased. Learn more about the connection between these two conditions and whether anticoagulant medications are a beneficial treatment for this possible effect. Does ulcerative colitis cause bleeding or blood clots? People with ulcerative colitis are three times more likely to experience a thromboembolism (blood clot) compared with those who don't have ulcerative colitis. It's important to remember that blood clotting is your body's natural response to bleeding. You need your blood to clot so you won't bleed excessively. It's important to keep a balance of blood clotting factors so they won't cause you to form a blood clot when you don't need to. Symptoms of blood clots with UC Doctors first connected an increased risk of blood clots with ulcerative colitis when they observed young people experiencing blood clots at a younger-than-expected age. If you have ulcerative colitis, it's important to be aware of your increased clotting risk, but also to know the incidence of a clot is about 1% to 8% of all people with ulcerative colitis. Blood clots can cause a venous thromboembolism, which is a clot that usually forms in a deep vein of your leg. Doctors call this deep vein thrombosis (DVT). Symptoms of a DVT include: discoloration of your leg or red-appearing streaks leg pain/tenderness leg swelling part of your leg feels warm to the touch However, clots can also travel from your legs to your lungs, which doctors call a pulmonary embolism (PE), or blood clot in the lungs. Symptoms of a PE include: chest pain that worsens with breathing feeling dizzy losing consciousness rapid heart rate sudden shortness of breath very fast breathing If you experience these or other clot-related symptoms, get emergency medical attention. What is the safest medication for ulcerative colitis with bleeding? Clotting requires a multi-step process. Anticoagulant medications target different steps in this process to prevent clots from forming when they aren't supposed to. However, anticoagulant medications may increase your risk of more severe rectal bleeding when you have an ulcerative colitis flare-up. For this reason, doctors won't usually prescribe anticoagulant medications to you unless you're in an active flare-up (and usually in the hospital), after a surgery, or have already had a blood clot in the past. Each of these instances increases your risk of blood clotting. The most common recommendation if you are in the hospital with active IBD is to go for walks. A number of anticoagulant medications are available, and which one your doctor prescribes may depend upon how long you're going to take it, your overall health, and even what medications your insurance will cover to help keep your costs low. There's no one medication that's the 'gold standard' of anticoagulation treatment for a patient. Examples of anticoagulation medications include: If a doctor does prescribe anticoagulants to you, you can ask how the medication works and why it may be the best option for you. Living with ulcerative colitis Getting an ulcerative colitis diagnosis can be understandably life changing. It's important to get help and support so you can manage your condition and live well. Some resources include: American College of Gastroenterology Crohn's & Colitis Foundation Connecting to Cure Crohn's & Colitis IDB Support Foundation Bezzy IBD Community Healthline also has a listing of numerous resources, social media pages, and blogs that can help.
