Is There a Safe Blood Thinner?

For those who can’t stand the sight of blood, I would advise against pursuing a career in gastroenterology.  We confront blood more often and more directly than nearly every other medical practitioner.  One of the most common reasons we are called to see hospitalized patients is to evaluate internal bleeding that originates somewhere within the alimentary canal.  It is then our task to identify the exact site of leakage and to caulk the leak, if possible. 

As even a casual TV watcher knows that blood thinning medications are ubiquitous.   In the olden days, there was Coumadin (aka warfarin), which is still in use today.  It is a rather clumsy drug that requires frequent monitoring and dosage adjustments.  At times, and for no apparent reason, a Coumadin user’s blood will become thinner than desired and internal bleeding may result.  More recently, new generations of blood thinners have emerged giving physicians many new ways to thin their patients’ blood.  These newer agents are expensive, but no dosage monitoring is necessary.

As you might expect, many of the internal bleeding patients we confront are also on a blood thinning agent which adds to the seriousness and complexity of these cases.   If, for example, an individual develops a bleeding ulcer, imagine the potential consequences of this event if a blood thinning agent has stifled his clotting capability.   And, most patients who are taking a blood thinner are likely to have many other medical issues, which increases the risk of an unfavorable outcome.   

A Stomach Ulcer. 

 If this patient were on a blood thinner, this scene might be a bloody mess.

The ideal blood thinner would thin the blood enough to achieve the desired outcome, but not enough to precipitate internal bleeding.  The pharmaceutical companies have not been able to devise such a finely tuned drug yet.   Blood thinners save lives, but they can be bloody dangerous.

For many individuals, blood thinning agents are lifesaving.  But, they have significant risks that need to be soberly weighed.  A few days before writing this, I saw an 86-year-old frail female whose cardiologist wanted her to restart a blood thinning agent because she had an irregular heart rate and this would reduce her risk of a stroke.  The patient was reluctant because some months ago, she fell and sustained a head injury with bleeding.   What advice would you have given her?