I can’t count how many times I’ve been asked, “Doc, do I have to be on this blood thinner?”
There’s something about Coumadin, and its blood thinning cousins, that elicits an “anything-but-that” response from about half the folks who are on it. In addition to the side effects and fear of bleeding, people dislike the nature of this drug (it’s rat poison in high quantities), as well as the discomfort and inconvenience of having to get blood tests every 4–6 weeks.
So, let’s review anticoagulants like Coumadin and try and allay some of your concerns. First off, Coumadin has an unparalleled ability to thin the blood and prevent clots which can cause strokes. This is especially true if you have mechanical heart valves, suffered an embolic stroke, have atrial fibrillation (AF), or had an extensive heart attack.
But, like any drug, Coumadin does have side effects. The major one is excessive bleeding (bleeding gums, eye hemorrhages, blood in the urine, and even a few bleeds in the brain). Yet, other rare reactions include weakness, cold sensations, itchy skin, fever and abdominal discomfort.
Given the strong positives, and negatives, the decision of whether to begin—or go off of—Coumadin can be a very difficult one. Patients and their doctors often struggle together for the right answer. So let me offer some guidelines to help make this decision easier for you.
* Coumadin is your best therapy—mandatory even—to prevent blood clots if you have mechanical heart valves.Studies show that it’s more effective than aspirin with other anti-platelet drugs. It should also be your first choice if you’ve suffered an embolic stroke.
* As I mentioned earlier, Coumadin has been shown to protect patients with left ventricular clots which can cause thrombotic strokes.
* If you have AF, your best bet is Coumadin versus other blood thinners like aspirin. The reason is that if you’re not on conventional blood thinners like Coumadin, your risk of stroke is at least 5–6 times greater than those who are. This in itself is a disaster! In fact, approximately 75,000 strokes a year are attributed to AF.
* Aspirin is less effective for preventing clots and strokes, particularly in women and people over 75. The best advice I can give anyone with more than two episodes of AF a year is to take Coumadin. If you have fewer episodes of AF and no other health problems like diabetes, congestive heart failure, leaking heart valves, or an enlarged heart, aspirin is a second choice.
Finally, I want to mention that you never want to discontinue any medication without consulting your doctor first.
Now it’s your turn: What are your feelings about Coumadin?
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