Midlife drugs you should not combine: Blood thinners and aspirin

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If you ask a doctor who works in a busy public clinic what are the major medical conditions of mid-lifers frequently encountered these days, he or she may say: stroke, kidney failure, heart failure, diabetes and the complications of such conditions. Even though most people would wish: “Not my portion!”, by midlife some force on earth has managed to apportion these deadly diseases to many people as they make their journey through life.

Thus there are some drugs that are frequently prescribed and we may have them in our homes.    Let us look at anticoagulants.

Anticoagulants are used to lower the risk of blood clots.  Blood clots blocking the inside of fine blood vessels can lead to stroke and death. A blood clot (or thrombus) is blood that has changed from a liquid form to a gel-like or semisolid state. A clot is formed when there is a breach or injury in a blood vessel wall that can cause blood leakage and blood loss.  When we have a small cut on our skin, blood flows from superficial blood vessels and then stops because of the blood clot that forms at the site of injury.  The clot blocks the breach and allows repair processes to go on.  Within the body, when a clot forms inside a blood vessel (such as a vein that returns blood towards the heart or an artery that carries blood towards body tissues), it can block /embolism the vessel.  This decreases the flow of blood through the vessel causing harm at the site of origin or at the destination of the blood flow.

Blood clots (thrombi) in the heart tissue can starve the heart of blood nutrients including oxygen and stop the work of the heart in pumping life-giving blood to the rest of the body.  Blood clots in the brain tissue can similarly kill part of the brain and upset the work of the brain in directing the well-being of the body. Blood clots in the lung tissue can kill part of the lung and limit the function of the lung in breathing in oxygen and passing out waste gas, carbon dioxide.  Blood clot anywhere in the body including veins in the legs and blood vessels in the kidneys, can cause disaster.  Thus in persons who are prone to having blood clots, physicians may prescribe a ‘blood thinner’, a drug that inhibits the clotting of blood.

Certain people with conditions such as heart rhythm disturbance, high blood pressure, high cholesterol, diabetes, trauma or local injury, or smokers, or people using oral contraceptives may be prone to developing blood clots.  People who have had a heart valve replacement or some other surgeries have a risk of blood clots developing.  People with pancreatic or lung cancer, multiple myeloma, or hematologic malignancies may develop blood clots due to cancer-specific factors and their treatment regimens. These patients are often given prophylactic (preventive) blood thinners.

Many mid-lifers settle into sedentary life styles with very little mobility; hours at a desk, hours before the TV, hours with a laptop without getting up to stretch and exercise.  This can promote blood clots.  The contraction of muscles (e.g. in the legs) helps to sustain the cycle of movement of blood between the extremes of the body and the heart.   Blood that is not flowing well or that stagnates is prone to clot formation. Deep vein thrombosis, DVT, occurs in a deep vein such as in the leg, arm, or groin. It can break loose and cause disaster, for example in the lung (pulmonary embolism), or heart (heart attack). Many mid-lifers reach top level positions at work that are more cerebral than physical.  Mid-lifers need to exercise well and to be at least minimally physically active. Bosses should not avoid menial tasks for their own good health.

To avoid stroke, heart attack, or peripheral artery disease, blood thinners have become a group of drugs that doctors prescribe often. Blood thinners (technically called anticoagulants) include heparin (e.g. enoxaparin injection, Lovenox); vitamin K antagonist warfarin (Coumadin, Jantoven), acenocoumarol, and phenindione,; direct oral anticoagulants (DOACs):  apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa); and direct thrombin inhibitor dabigatran (Pradaxa).

A person using a blood thinner who decides to take pain killer aspirin because of some unbearable pain may be precipitating trouble. Aspirin is also a blood thinner in its own way.  It is an antiplatelet drug which means it prevents blood cells called platelets from clumping together during formation of a clot. Aspirin should not be taken with blood thinners because the combination can lead to serious internal and external bleeding all over the body. The person may become bloody.  Similarly a person taking aspirin who mistakenly swallows rat poison (made of coumadin) can end up bleeding to death.

Blood thinners may interact with certain foods, medicines, vitamins, and alcohol. If you are on a blood thinner, you should discuss with your doctor to get pain killer, cold medicine, stomach medicine, herbal medicine, and vitamin products, are safe for you because some of these drugs are a disastrous combination with blood thinners.  Drugs may increase or decrease the function of blood thinners.  The blood thinner needs to work enough to prevent dangerous blood clots but not too much to cause dangerous bleeding.

– Sept. 7, 2018 @ 16:47 GMT

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