In a new study, researchers found strategies that providers might use to help their patients better balance the risks and benefits of blood thinner drugs.
The research was conducted by a team at Michigan Medicine.
For some patients on blood thinners, gastrointestinal bleeding caused by those medications is an adverse event that can be disabling or even fatal.
According to the team, some patients are simply taking too many blood-thinning drugs that increase their bleeding risk, while others could start another medication to reduce the risk of gastrointestinal bleeding,
And those takeaways build on previous research that shows the use of just one low-dose anticoagulant already nearly doubles the risk of upper gastrointestinal bleeding.
The team says anticoagulation strategy is all about the balance between preventing blood clots and reducing the risk of bleeding complications.
They studied 6,907 patients who started using the popular anticoagulant warfarin (also known as Coumadin or Jantoven) between 2011 and 2018.
Nearly half faced an avoidable danger: 45% of the patients on warfarin were also using anti-platelet therapy such as aspirin, which increases the risk of bleeding.
The researchers found overall, 36% of the patients in our study could benefit from one or both of the strategies we present to reduce the risk of GI bleeding.
The team says many patients may not need to take a medication like aspirin if they’re already taking warfarin.
They couldn’t find a reason for the second anticoagulant for about 30 percent of the high-risk patients who were on multiple blood thinners.
These patients may be able to reduce their risk of GI bleeding simply by stopping one of their blood thinners.
Some appropriate indications for adding anti-platelet therapy to prevent blood clots in patients already taking warfarin include a recent history of coronary artery disease or heart attack, peripheral arterial disease, coronary artery stents, bypass surgery, stroke or mini-stroke (TIA), or an autoimmune disorder called anti-phospholipid antibody syndrome.
For patients that actually do need to take multiple blood thinners, such as warfarin and clopidogrel, the researchers found that adding a proton pump inhibitor (PPI) such as omeprazole (also known as Prilosec) could help suppress acid production in the stomach.
The theoretical risks of PPIs need to be weighed against the real risk of bleeding.
In patients at high risk for bleeding, like those on warfarin and aspirin, the benefits of PPIs for prevention generally outweigh the risks.
Bleeding is a common cause of GI hospitalization that is often quite predictable beforehand.
One author of the study is Geoffrey Barnes, M.D., M.Sc., a vascular cardiologist at the University of Michigan.
The study is published in Vascular Medicine.
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