Normally, the clotting ability of blood is a good thing, otherwise we could bleed to death from a small cut. But sometimes blood clots can be dangerous. They can prevent blood flow to the lungs, heart or brain (ischemic stroke).
However, if blood cannot clot properly, a hemorrhagic stroke (brain bleed) can happen, and around 10% of strokes are this type, many of those due to an overdose of warfarin or similar blood-thinning medication.
So one must use caution and common sense for using any prescription and/or natural blood thinner.
Prescription blood thinners are normally anticoagulants or antiplatelets, and are commonly prescribed to seniors if doctors presume the patient is at risk for a blood clot, particularly for DVT (Deep Vein Thrombosis).
Anticoagulants such as warfarin do not thin the blood, they make the blood take longer to clot.
The blood test to measure the time to clot is the PT (prothrombin time, or protime) test, and reported as the INR (International Normalized Ratio).
Common Anticoagulant drugs include:
- Warfarin (Marevan, Coumadin, Jantoven)
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
Common Antiplatelet drugs decrease platelet aggregation (clumping together), inhibit thrombus (clot) formation and include:
- Clopidogrel (Plavix)
- Ticagrelor (Brilinta)
- Prasugrel (Effient)
- Dipyridamole/Aspirin (Aggrenox)
- Ticlodipine (Ticlid)
- Eptfibatide (Integrilin)
Common Thrombolytic Agents (clot-busting drugs):
- Eminase (anistreplase)
- Retavase (reteplase)
- Streptase, Kabikinase (streptokinase)
- Activase (alteplase, t-PA or tissue plasminogen activator)
Side effects of prescription drugs
Anticoagulants all have bleeding side effects.
Symptoms such as these must be reported to your doctor immediately, or go to your nearest hospital, or in Australia call the Poisons Information Centre: 13 11 26 if any bleeding symptoms arise:
- Blood in urine (red or dark brown)
- Blood in poop, red or black poop
- Severe bruising
- Prolonged nosebleeds
- Bleeding gums
- Vomiting blood
- Coughing up blood
- Heavy periods
- Purplish & mottled toes
- Prolonged bleeding from cuts
- Swollen ankles
- Painful swelling or discomfort
- Stomach pain
- Chest pain
- Joint pain
- Persistent headache or fever
- Difficulty breathing or swallowing
- Severe skin wounds
- Non-healing wounds, lesions or mottling of skin
- Persistent diarrhoea
Warfarin (Marevan, Coumadin, Jantoven) – was originally developed as a rat poison, designed to cause bleeding to death, as warfarin is a very strong anticoagulant.
For this reason, those taking this drug for the first time need regular blood tests (INR test) to find the correct dosage.
Warfarin and other trade names use a colour chart for the different dose prescribed. If traveling to a different country, ensure that the dose prescribed is the dose you are receiving if you are filling a prescription, as these colours may vary in different countries.
In Australia, warfarin is sold as Marevan in doses of 1 mg (fawn), 3 mg (blue) and 5 mg (pink), and all are scored and bevel edged with “M” embossed on one side above the score and “1”, “3” or “5” embossed below.
Many foods and supplements will increase or decrease the effectiveness or warfarin, so diet must be completely controlled. Because one of the antidotes for warfarin overdose is Vitamin K (phylloquinone), which comes mainly from leafy greens, then all foods containing Vitamin K must be consumed on a regular basis, including the amount, quality and type. This control can be difficult for many people, and combined with inaccurate dosing, can be lethal. Many seniors, especially those with conditions leading to warfarin medication, have poor memory and cognitive ability, and can easily skip a dose, or worse, double up a dose if they forget they had already taken a dose. This is why warfarin overdose is one of the leading cause of Emergency Room visits for those over 65.
In a life-threatening bleeding situation, the hospital will administer PCC (Prothrombin complex concentrate), a medication made up of several blood clotting factors, and in addition, up to 10mg of Vitamin K administered by IV.
In a less serious overdose, Vitamin K is administered by IV at first, then oral supplementation until INR levels have stabilised, which can take up to 2 weeks.
Warfarin side effects
Because warfarin, heparin, and other anticoagulants are Vitamin K antagonists (they deplete Vitamin K from the body), they can interfere with bone metabolism and cause osteoporosis and fractures, as the job of Vitamin K (mainly K2 MK7, or menaquinone) is to remove calcium from blood and from blood clots (which are high in calcium) and place it into bones and teeth where it belongs.
Another issue is that without Vitamin K, blood will be higher in calcium, which ends up in blood clots, heart valves, liver, kidneys, etc, causing many other health problems.
Patients receiving dialysis for kidney issues should not take large amounts of Vitamin K.
Commonly used medicines and products that can interfere with Marevan/Warfarin include:
- Medications for arthritis, including glucosamine and chondroitin
- Medications for blood clots, heart attacks or angina
- Antihistamines or any cough or cold preparations
- Some antibiotics
- Vitamin C
- Vitamin E
- Vitamin K
- St John’s Wort
- Some herbs, e.g. garlic, ginseng, feverfew, gingko biloba, ginger
- Cranberry juice
- Large amounts of green leafy vegetables and/or significant diet changes
In spite of all of the dangers of warfarin, it is the most commonly prescribed anticoagulant drug.
Heparin is listed above as an anticoagulant because it works faster, but normally only used in emergency situations in a hospital, given by IV or as an injection into subcutaneous fat.
Rivaroxaban (Xarelto) is a newer (Factor Xa Inhibitor) anticoagulant drug.
At December 2018 it is not listed on the TGA website, so no antidote such as Andexxa is available in Australia. A bad bleed can more easily be fatal compared to warfarin.
In the USA, Andexxa (Andexanet alfa) was approved by the FDA in May 2018 for limited release, and appears to work as an antidote for Xarelto and Eliquis.
In 2016 there were more than 117,000 hospital admissions in the USA for uncontrolled bleeding, where Andexxa could have been used, but the wholesale price of Andexxa is reported to be US$27,500 (AU$37,500) for one patient dose, and a typical treatment would be about US$53,000 (AU$75,000) so LeanMachine would advise those wanting blood thinners to be very careful and ask the following questions:
1. Does my local doctor or Hospital carry the appropriate antidote for my blood-thinning medication?
2. What happens if for example I fall and hit my head, or I am in an accident where I have large wounds? Is there any treatment for bleeding?
3. How much would I have to pay for the antidote?
More info on this antidote www.emcrit.org/emcrit/issues-andexanet.
Common side effects of Andexxa include pneumonia and urinary tract infections. Severe side effects include blood clots or cardiac arrest.
Because Xarelto and Eliquis work in a different way (Factor Xa Inhibitors) from warfarin, Vitamin K will have no effect on Factor Xa Inhibitors.
Important: When adding supplements or foods to the diet, and if already taking prescription blood thinners, be aware that the combination of drugs with some natural products can make blood too thin, while others can interfere with the function of some drugs, reducing their effectiveness. Always discuss diet and supplements with your doctor.
Rutin also called rutoside, quercetin-3-O-rutinoside and sophorin, combines the flavonol quercetin and the disaccharide rutinose and is a citrus flavonoid found in citrus fruits and other plants.
Rutin is a far better alternative to Aspirin, which has been used for a hundred years to reduce fever, inflammation and blood thinning.
The famous 1918 Pandemic (Spanish flu or Russian flu) killed 50 million people worldwide, but aspirin significantly contributed to these deaths by reducing fever and suppressing immunity. Combined with poor sanitation and poor foods at the time, this led to pneumonia and death.
Fever is the body’s automatic defense against infection as the higher temperature kills the pathogens. When the fever is artificially reduced by aspirin, the pathogens multiply.
Aspirin also plays a part in internal bleeding (mainly in the gut) and in Macular Degeneration by causing blood vessels in the eye to leak, distorting the retina and affecting central vision.
Rutin actually strengthens the endothelial lining of blood vessels and improves flexibility, preventing leakage, reducing risk of clots, while improving blood flow at the same time.
Rutin also helps heal bruises, spider veins, and varicose veins, and prevents mucositis, a side effect of cancer treatment.
Another benefit: Rutin increases bone density by slowing down bone resorption.
Read more about Flavonoids here: www.leanmachine.net.au/healthblog/flavonoids
Bacopa (Bacopa Monnieri) has many benefits, including thinning the blood, especially in the brain, reducing pain and anxiety, improving memory, protecting against oxidative stress, improving communication between neurons, reducing β-amyloid plaque accumulation (a hallmark of Alzheimer’s disease), and has been used to treat ADHD.
Uncommon side effects include increased bowel movements, stomach cramps, nausea, dry mouth and fatigue.
Co-Enzyme Q10 (CoQ10) is traditionally used for improving heart health and mitochondrial function, especially to counteract the effect of statin drugs that destroy CoQ10 production (and the precursor to Vitamin D3) in the liver.
But blood-thinning is a less well-known side effect. This is one of LeanMachine’s must-have supplements for those over 40.
Side effects are rare, but may include mild episodes of stomach upset, appetite loss, lower blood pressure, nausea, vomiting, diarrhea and allergic skin rashes in some people.
Garlic is well-known for the blood-thinning properties, either in supplemental or original form. The supplemental form here is aged for potency and odourless for those who dislike garlic odour.
Other benefits beside blood-thinning are cardiovascular benefits.
Side effects of real garlic include bad breath, body odour, heartburn, indigestion, mouth irritation, and probably should not be eaten raw.
Ginkgo Biloba not only thins the blood, but strengthens endothelial cell lining of all blood vessels.
Read more about Ginkgo Biloba: www.leanmachine.net.au/healthblog/gingko-biloba-a-living-fossil-with-life-extending-properties
Cayenne Pepper has blood-thinning properties owing to the high salicylate content, although more famous for cardiovascular health properties. Supplements are preferred when the patient does not like or tolerate real cayenne peppers.
Turmeric, a spice giving curry the yellow colour, has long been used for many health conditions, and the main ingredient Curcumin is a natural antiplatelet.
Also good for joints, cardiovascular, cancer and many more health conditions.
Ginger is in the same family as turmeric and contains salicylate, an acid found in many plants. Acetyl salicylic acid (Aspirin) is derived from salicylate and can help thin blood, but has side effects noted above. Foods containing salicylate include avocados, berries, chilies and cherries can also reduce blood clotting.
Nattokinase helps prevent or reduce blood clots by breaking down fibrin, a mesh-style substance that holds a clot together. This particular version has all of the Vitamin K removed.
Vitamin E is mild anticoagulant.
Vitamin E has 2 main types: Tocotrienols and Tocopherols, with each type containing alpha, beta, gamma and delta sub-types. This product contains all types.
Beware: Cheap Vitamin E products contain only d-alpha tocopherols and none of the other 7 types. Nuts are one of the best food types containing Vitamin E.
Recently, a study confirmed that a combination of two herbs, Gotu Kola and Pine Bark improved artery health in one study. Pine bark extract reduced areas of plaque and fat deposition in atherosclerotic mice, while decreasing total cholesterol and triglycerides and increasing beneficial HDL cholesterol. Gotu Kola protects the hard cap that naturally forms over existing arterial plaques, reducing the chance of a rupture which can cause a fatal cardiovascular event. A study showed those taking Gotu Kola had a 41% lower risk of a cardiovascular event.
But the study of the combination of the two, with 150 mg of Pine Bark and 225 mg of Gotu Kola daily caused a beneficial increase in plaque density, while decreasing plaque length, height and number, and 95% of the study participants had significantly improved blood flow and reduced cardiovascular events.
Best to go with the natural products that work:
Another study on Pomegranate Juice, including subjects with carotid artery stenosis (70–90% blockage), found that one glass of pomegranate juice daily reversed plaque accumulation. I do not know of any prescription drug that comes anywhere near this result. Standard medical practice is to insert a stent in the artery via a medical procedure, but these can have many problems.
In the study, researchers measured the mean Tunica Intima (artery lining) media thickness in the left and right common carotid arteries in severe carotid artery stenosis patients.
In those that consumed pomegranate juice for up to 1 year, the thickness was reduced after 3, 6, 9 and 12 months of pomegranate juice consumption by 13%, 22%, 26% and 35%, respectively, in comparison to baseline values. Thickness of the Tunica Intima indicates hard, inflexible, diseased arteries.
Foods known to help improve blood flow include:
- Vegetables such as lettuce, tomatoes, broccoli, garlic and onions
- Fruits such as berries, grapes, grapefruit, pineapple and pomegranate
- Nuts such as walnuts, almonds, hazelnuts, cashews, pistachios and brazil nuts
- Fish such as salmon, trout, herring and tuna
- Drinks such as pomegranate juice, green tea, grape juice, cranberry juice and pineapple juice
- Dark chocolate (high cocoa content)
- Cacao (unrefined cocoa)
The objective in thinning blood is to increase blood flow.
Those consuming junk food (processed foods) will have “sticky blood” and rather than using dangerous prescription medication, changing the diet to healthy foods and keeping well-hydrated helps keep our blood vessels healthy, so we have a reduced risk for clots, and our blood has better “flowability” without reducing our clotting ability for those times when we need it.
Any information here is for educational purposes, and the needs of each individual varies, so everyone should consult with their own health professional before taking any product to ensure that there is no conflict with existing prescription medication.
LeanMachine has been researching nutrition and health since 2010, and has now examined thousands of studies, journals and reports related to health and nutrition and this research is ongoing.
Updated 26th January 2020, Copyright © 1999-2020 Brenton Wight and BJ & HJ Wight trading as Lean Machine abn 55293601285