Caring for Someone on Blood Thinners
For people with heart disease, blood vessel diseases or poor circulation, blood-thinning medications can be a life saver. According to the National Blood Clot Alliance, 2 to 3 million Americans are prescribed blood thinners to help prevent blood clots and reduce a person’s risk of heart attack and stroke. However, these drugs have some side effects and lifestyle implications that caregivers should be aware of.
Two Types of Blood Thinner Medications
Anticoagulants are the most common blood thinners prescribed to seniors. A popular one is warfarin, which goes by the brand names Coumadin and Jantoven and is administered in pill form. Popular alternatives to warfarin include dabigatran (Pradaxa), rivaroxiban (Xarelto) and apixaban (Eliquis). Heparin (brand names Clexane and Lovenox) is another commonly prescribed option, although it is taken by injection rather than orally. These drugs are used as aggressive treatments for patients with atrial fibrillation (a dangerous type of arrhythmia also known as AF or AFib) or those who are at a high risk for stroke.
Anti-platelet drugs are another pharmaceutical option commonly prescribed as a less aggressive treatment for patients prone to thrombosis or thromboembolism due to conditions like angina, peripheral artery disease (PAD) and recovery from recent heart surgery. Examples include aspirin therapy and clopidogrel (Plavix).
Although anticoagulants and anti-platelet medications employ different mechanisms to prevent blood clots and ensuing cardiovascular and cerebrovascular events, they both pose risks for increased bleeding. Your loved one’s doctor will determine which one is the best fit for their condition. Although there may be some similarities between these two treatment options (such as the need to avoid injury and bleeding), this article addresses restrictions and suggestions for caring for a loved one who is specifically taking an anticoagulant drug.
Is Their Blood Thinner Working?
Getting used to taking one of these drugs can be a process for both a patient and their caregiver. One of the most notable side effects is excessive bleeding and bruising. Patients sometimes experience “nuisance” bleeding that will not stop, like nose bleeds. Injuries that would be considered minor for most people may bruise or bleed excessively for people on anticoagulants.
To make sure this medication is working and the correct dosage is being administered, your loved one's doctor will prescribe regular prothombin time (PT) blood tests to measure how long it takes their blood to clot. This test can also find the cause of abnormal bleeding or bruising and check their liver function.
PT results are reported as an International Normalized Ratio (INR). The normal range for people who are not taking blood thinners is about 0.9 to 1.1. Someone who is receiving anticoagulation therapy should have results between 2 and 3.5 if their medicine is working correctly. The higher a patient’s INR is, the longer it takes their blood to clot and the higher their risk for bleeding is. However, if their INR is too low, it increases their risk of suffering a dangerous clotting event. An INR of 5 or more is considered dangerous. If a senior’s numbers are outside of the above target ranges, it could be due to a bleeding disorder or reduced liver function, or it could simply indicate that lifestyle changes and/or alterations to their prescription are needed.
The frequency that PT tests should be taken is determined by a doctor. If your loved one’s insurance company covers the medical equipment and expenses, or they meet certain Medicare eligibility requirements, they may be able to administer the test at home with a point-of-care (POC) device. These devices use a simple finger prick (similar to a blood glucose test for diabetics) to obtain a small blood sample for testing. Patients who test at home usually need to test more often (up to once a week) than those who go to a lab or doctor's office since less expense and time are involved. This option may be best for a senior who has mobility issues but must closely monitor their INR. A person whose health and blood tests have been stable for some time typically only needs to have a PT test done once a month.
Diet and Blood Thinners
Blood thinners can pose challenges for both a patient and their caregiver when it comes to making wise dietary choices. Many family caregivers grocery shop and prepare meals for their loved ones. It can be difficult to provide healthy meals that seniors will eat, even without added dietary restrictions, but it is very important for those on anticoagulant medication to stick to a consistent diet.
The biggest concern for these patients is the consumption of vitamin K, which is known as the “clotting vitamin.” Consuming too much of this nutrient can interfere with how anticoagulants work.
Men are recommended to get 120 micrograms (mcg) of the vitamin per day and women should aim for 90 mcg. Some very healthy foods like broccoli, kale, Brussels sprouts and spinach are high in vitamin K, but caregivers should help their loved ones monitor their intake. The goal is to keep their consumption consistent from week to week to prevent any significant fluctuations that could interfere with their anticoagulation therapy. Many nutritional drinks and meal replacement shakes and bars, such as Ensure or BOOST, contain vitamin K, so keep an eye on the use of these products as well.
Online sources that show how much vitamin K is in various serving sizes of certain ingredients can be helpful. If you are struggling to come up with healthy meal ideas, online cookbooks can help you find recipes that will not interfere with your loved one’s medications. Depending on the complexity of their dietary requirements and limitations, a registered dietician or a certified nutritionist can provide further support.
Alcohol can also affect the performance of these medications. If your loved one has a drink now and then, it should not be a cause for concern. Consistency in moderation is just as important for alcohol consumption as it is for food. Overindulging should definitely be avoided, though, since alcohol has blood thinning or anti-platelet effects.
The article, Caring for a Loved One on Blood Thinners, originally appeared on AgingCare.com. AgingCare.com is an online resource that connects family caregivers, shares informative articles, provides answers and support through an interactive Caregiver Forum, and offers search capabilities for senior living options for elderly loved ones.
