SILVER LININGS TO ANTICOAGULATION RISKS

Although the advantage of thinning the blood is clear, it does carry risks.

When we thin the blood, we increase the risk of bleeding, particularly bleeding into the brain and also into the gut. So, the risk of a haemorrhagic stroke increases with the use of blood thinners and any lesions within the gut have a greater propensity to bleed.

Is there a silver lining to these increased risks? Are there other situations where the effect of blood thinners could be beneficial?

The one that comes immediately to mind is long distance travel and the potential to develop a clot in the leg. Bad. This can lead to a pulmonary embolism if the clot moves to the lungs. Really bad. The possibility of this very serious condition developing can be mitigated by taking an anticoagulant.
Is there a similar silver lining from increased risk of bleeding?

Over the years, I have seen a number of my patients who have had bowel cancer detected early because they were taking anticoagulants. This is how their increased propensity to bleed was a benefit.

One of the screening tests routinely used looks for evidence of blood in the bowl motion or stool. That blood is in the bowel motion because a problem in the bowel, the beginnings of a cancer, is scraped by the faeces moving past, causing bleeding and a small amount of blood ends up in the stool. This screening test is called a faecal (faeces) occult (not easily seen) blood test. If a person is on a blood thinner when one of the early cancers is rubbed, it is more likely to bleed, with the possible result of showing an abnormality.

Whether or not you are on warfarin or a NOAC, it might be a good time to ask your local doctor if you are due for a faecal occult blood test looking for an abnormality in the gut.

Catch bowel cancers as early as possible for the best chance of a good outcome.

It’s also an interesting thought that maybe in the future, to try to increase the sensitivity of the test, that faecal occult blood testing could be combined with the person taking an anticoagulant, for a few days, before the test. I have not seen any data about this. However, it is an entertaining and potentially useful consideration.

IMPORTANT POINTS
THINNING THE BLOOD

•    The coagulation cascade results in a ‘plug’ of platelets and fibrin.
•    We thin the blood
-    acutely, with heparin, clexane, NOACs
-    long-term, with warfarin or NOACs.
•    When using NOACs, there needs to be checks on kidney function and consideration of the valves of the heart.
•    When using warfarin, there needs to be monitoring of the INR and consideration of possible interactions with other drugs, foods.
•    Advent of the NOAC agents has reduced reliance on the use of warfarin.

One of my soapboxes is encouraging patients, especially those on blood thinners, to know the medications they are taking and to carry a list in case of an emergency.

Why?

Well, imagine if you are out, fall and end up unconscious. Do you think it would be helpful for your treating doctors at the hospital to find a list in your wallet that lets them know you are on an anticoagulant? Do you think it could save your life? You bet it could! So, please, please, please, always have an up to date list of medications in your wallet or purse. It will ensure you have the chance of receiving the best health care, especially in the case of an emergency.