Are blood thinners safe for Elders?

Safety of Blood Thinners in Elderly

As our seniors age, their bodies change. This natural change can alter the way their prescription drugs are absorbed and utilized. This could affect how quickly the drugs enter our seniors’ blood, break down, get absorbed and exert their influence.

The effects that we expect to occur may be changed – either heightened or lessened – resulting in unsafe outcomes. Many seniors also experience a change in their body weight as they age, with many losing weight and muscle mass. This could affect the amount of medication that is required to achieve a particular outcome.


If a senior’s body needs less of a medication than what the dosage gives them, they could have an adverse drug reaction from excessive amounts. On the contrary, if they need more of a medication due to weight gain or other factors, their medicines won’t help the condition for which they were prescribed.

If their circulation is affected as they age, the amount of medication in their blood may be more than anticipated because the blood no longer circulates as quickly causing the medication to be used by their tissues differently than expected.

Key organs, such as the kidneys or liver, may also be functioning below par, which can affect the amount of medication available to the body. When these organs slow down, the amount of drugs in our seniors’ bloodstream, or the waste products they create, may not be cleared as designed. This can lead to side effects and other problems.

It is important for our seniors to be aware of the various interactions that affect them and their many medications, including the over-the-counter pills they are taking.

When the amount of medication in the bloodstream becomes altered due to lower body weight, altered circulation or reduced functioning of organs, they could be at an increased risk for dangerous interactions unforeseen even by their doctor.

Drug Interaction Problems

The possibility of our seniors taking more and more prescription drugs increases greatly as they age and that doesn’t include the over-the-counter medications taken.

According to the American Society of Consultant Pharmacists, it has been estimated that adults 65 to 69 years old take nearly 14 prescriptions per year and adults 80 to 84 take an average of 18 prescriptions per year. Unfortunately, they estimate that around 15% to 25% of drug use in seniors is unnecessary or otherwise inappropriate. Adverse drug reactions and noncompliance are responsible for 28% of hospitalizations for older adults.

It is true that our seniors need more medicine as the years go on to treat the variety of chronic diseases that affect them as a result of aging. The statistics above for the overwhelming number of pills they take each day doesn’t include the multitude of over-the-counter remedies they use, which can be more difficult to measure. What also increases besides the number of medications they take, are the harmful effects medications can have on seniors as they get older.

In this article, particular focus will be given to the safety of blood thinners on seniors.

What do you mean by blood thinners?

They are drugs taken orally or intravenously that help in preventing formation the of blood clots. These drugs are given to those people who are at a high risk of getting clots and to reduce their risk of developing serious conditions such as heart attacks and strokes.

The blood clot is a seal created to stop bleeding from wounds. They’re useful in stopping the bleeding but they can also cause blockage of blood vessels and hence stop blood from flowing to vital organs like the heart, brain or lungs if they form at the wrong place.

Examples of diseases and health conditions that require treatment with blood thinners to reduce the risk of clots forming, or to prevent life-threatening problems, include:

  • Deep vein thrombosis (DVT)
  • Heart attack
  • Stroke
  • For the prevention or treatment of:
  • Pulmonary embolism
  • Blood clots within venous and arterial catheters
  • Stent thrombosis
  • Blood clots during atrial fibrillation (afib) treatment

Blood Thinners – Types

There are two types of blood thinners. The first type is called anticoagulants. They keep our blood from turning into solid clumps of cells that stick together or clot. Most widely used anticoagulants are:

  • Heparin
  • Warfarin
  • Fondaparinux
  • Dabigatran
  • Rivaroxaban
  • Apixaban
  • Dalteparin
  • Enoxaparin

The second type of blood thinners are called antiplatelets. They target particularly the platelets which are tiny particles in the blood. These usually come in oral pill form. Most commonly used antiplatelets are:

  • Aspirin
  • Clopidogrel
  • Prasugrel
  • Ticagrelor

How do blood thinners work?

The blood thinners neither make the blood thinner nor can they break up the blood clots. They mainly keep your blood from forming new blood clots. They can also slow down the growth of existing clots.

The anticoagulants work by competing with vitamin K in the liver. For this, our body needs this vitamin K to make proteins called clotting factors. These clotting factors help in binding together the platelets (tiny pieces of blood cells) and other blood cells.

The main work of antiplatelets is to keep the platelets from sticking or binding to each other and also to keep them from sticking to the blood vessel wall. These antiplatelet drugs are weaker than anticoagulants. These drugs are often prescribed to high-risk people to treat for future blood clots, rather than to treat the existing clots.

What happens when blood thinners are stopped without the physician’s advice?

Things can go wrong when blood thinners are stopped, especially when the patient are at a high risk of forming clots. Stopping blood-thinning drugs can be fatal. According to research studies, patients being treated with warfarin have a significant risk of developing clots in the heart or brain if they suddenly stop taking the drug.

Statistics over the number of blood clots for every 1,000 patients during and after treatment with warfarin showed a considerable increase in the number of blood clots shortly after the patients stopped taking the blood thinners.

What are the most common side effects of these blood thinners?

The presence of blood thinners in your system can increase your risk of internal bleeding after an injury. Most common side effects are:

  • Easy bruising
  • Blood in urine or feces
  • Black or dark coloured stools
  • Frequent nosebleeds
  • Gum bleeding
  • Prolonged bleeding from a cut wound
  • Heavy periods
  • Vomiting of blood

You need to go to the hospital immediately if any of these side effects are experienced after falling or bumping your head, even if you don’t have any external bleeding.

What are the food and drug interactions while taking blood thinners?

Plenty of food and medicines can either increase or decrease the action of blood-thinning drugs, especially for the anticoagulant warfarin. Patients should particularly be aware of the foods that can interfere with anticoagulants and should avoid eating them often or in large quantities. Newer anticoagulant agents like dabigatran, apixaban and rivaroxaban however have only fewer dietary restrictions.

Most commonly used over-the-counter drugs like pain relievers, antibiotics, vitamin supplements particularly vitamin K, vitamin E, fish oil, herbal supplements and smoking or alcohol can affect the action of anticoagulants.

When you are on warfarin, avoid vitamin K rich foods like broccoli, spinach, cabbage, cucumber, kiwi, avocado and green leafy vegetables.

Take warfarin once a day at the same time each day as prescribed, usually in the evening. When you are taking warfarin, avoid binge drinking or getting drunk as doing this can increase the effect of warfarin and so increase the risk of bleeding.

Take antiplatelet drugs like aspirin with or after food to help reduce irritation to the stomach.

What happens if a dose of antiplatelet/anticoagulant drug is missed?

The patient can call the doctor if not sure what to do when a dose of anticoagulant or antiplatelet drug is missed. The doctor can tell exactly what to do, so that the patient does not take too much or too little of the drug. Then the patient will be as safe as possible. But there are general rules for what to do if a dose is missed.

When you remember it on the same day, take the missed dose at once. Then from the next day, go back to your regular schedule.

If you recall that you have missed it only the next day, or it is almost time for the next dose, don’t take the missed dose. Don’t ever double the drug dose in any one day to make up for the missed dose. Take your normal anticoagulant dose at the next regularly scheduled time.

Call your doctor if the dose is missed for 2 or more days.

Should you stop taking blood thinners before surgery?

The patients need to stop taking antiplatelets like aspirin, clopidogrel, etc. and anticoagulants like warfarin have to be stopped 5 to 7 days before major surgeries, cataract surgery and dental procedures.

What are the safety precautions while taking blood thinners?

Your doctor may tell you to limit your participation in contact sports to reduce the risk of bleeding. However, this doesn’t mean you can’t exercise or live a normal life. Swimming, walking and jogging are excellent forms of exercise and are safe for most people taking anticoagulants.

There are some safety precautions that are very important to follow.

  • By wearing shoes indoors and outdoors, one can prevent bleeding.
  • While doing yard work, wear gloves.
  • Use knives or scissors very carefully.
  • Instead of razor blades, an electric razor or hair removal cream can be used.
  • Waxed dental floss can be used instead of toothpicks.
  • Use a toothbrush that has soft bristles.
  • Use caution when cutting your finger and toe nails.
  • Anticoagulants like warfarin should be taken at the same time each day.
  • Patients should inform the health care provider that they are taking blood thinners.
  • Make sure that your pharmacist and doctors know all of the other medicines and vitamin or herbal supplements you are using.
  • Ask your pharmacist when buying over the counter medications if the medications can interfere with blood thinners.
  • Precautions must be taken, like withholding the drug for few days prior to certain medical and dental procedures in patients taking blood thinners.
  • You will probably need regular blood tests like PT/INR to check how well your blood is clotting. It is important to make sure that you’re taking enough medicine to prevent clots, but not so much that it causes bleeding.
  • Avoid certain foods, nutritional supplements and alcohol, which could interact with your anticoagulant.
  • Brand-name and generic forms of oral anticoagulants are not always identical in their effect, especially between countries. For this reason, it is extremely important to take along a supply of anticoagulant medication when traveling abroad.
  • Avoid situations that increase your risk of injury (e.g., sports that involve physical contact with other people).
  • Seek immediate medical attention if you are bleeding a lot or it takes a long time for the bleeding to stop.
  • Get medical help if you have a hard blow to the head as you may have bleeding inside without knowing it.

Dos and don’ts while taking aspirin tablet

Aspirin is prescribed for headaches, body-aches and fever. In the elderly, it is also used to prevent a heart-event for the first time, or prevent another heart-event when one has happened already. Aspirin reduces the clotting action, so, it helps prevent blockages in the heart that can cause heart attack. However, aspirin also thins the blood, which increases the risk of bleeding. That is why, there are some dos and don’ts around daily aspirin usage for the elderly, or people with heart issues.

  • Aspirin should not be taken if you have a bleeding or clotting disorder, aspirin allergy, asthma induced by aspirin, a history of GI bleeding or bleeding stomach-ulcers. Mention all these to the doctor before starting aspirin therapy
  • The doctor is the best judge of what dosage of aspirin you should take, so never change this dosage on your own.
  • NSAIDs such as iburprofen when taken with aspirin can increase bleeding. So, if you have been prescribed ibuprofen for some issue, mention this to the doctor, and ask for alternatives such as acetaminophen.
  • Prescription blood-thinners when taken along with aspirin can increase bleeding. So, mention this to the doctor who will prescribe alternatives.
  • Alcohol consumption during aspirin therapy can increase bleeding. In such a case, you will have to cut down alcohol consumption drastically.

Dr. S. T. Sakthi Suganya
Associate Consultant, Department Of Cardiology
Kauvery Hospital, Chennai