Which long term blood thinner is the safest?

Question

Which long-term blood thinner is the safest? Patients can be prescribed many different types depending on their needs. Such as Warfarin (Coumadin) for LVADs and heart valves, Eliquis or Xeralto for Afib, Plavix for stroke prevention, Lovenox or Heparin for DVT prevention. But the PO blood thinners are ones that patients can be on for months to a lifetime. Which one is the safest? Which one is the most dangerous? And what should I teach my patients

Answer 1

OTC 80mg (baby aspirin) is the safest for long-term prophylaxis.

Coumadin requires adjustments and lab work. Not recommended for noncompliant patients.

Lovenox requires injections (which people do not like) and risks HIT syndrome found in low molecular weight heparin.

Eliquis and Xarelto are fairly new to the market at less than ten years old and are similar in monitoring.

They all have medication contraindications, risks for bleeding, and dysrhythmias, along with extensive monitoring of side effects required. They all must be tapered or not briskly stopped.

However, to answer your question: Low dose aspirin is safest (still has risks), and Coumadin is dangerous (especially for non-compliant patients). You should always teach your patients to monitor for bleeding, risks for using razors and working anywhere with risks of cuts or injury. To take care when eating foods that reverse the effects of blood thinners (spinach, kale, Vit K, etc.) or foods that thin the blood (turmeric, ginger, cayenne, Vit E, etc.) and educate on potential drug interactions. Along with storage, double-dosing (missed meds) risks, bleeding management, compliance, when to call the doctor, and reasons for taking the medication in the first place along with long-term treatment, etc.