Know your blood thinners (Part 2)
In Part 1, we discussed one of the blood thinners, i.e. anticoagulants.
Why should you take antiplatelets?
Remember in Part 1 where we mentioned that if blood clot stucks in the veins of leg and lung, we will treat that using anticoagulants? But what if blood clot stucks in the arteries of important organs, such as the heart and brain?
It will lead to cardiovascular diseases such as chest pain, heart attack or stroke. That’s where antiplatelet comes into handy. Antiplatelet “thin” your blood by preventing platelets, an important component of blood clotting in your arteries, from clumping together to form a blood clot. For Part 1’s anticoagulants, they work by inhibiting clotting factors—a component that gives rise to fibrin, which is one of the materials that form blood clots in veins. Fibrin is the more important component of clots that form in veins, and platelets are the more important component of clots that form in arteries, although fibrin plays an important role in arterial blood clot as well.
Your doctor may prescribe antiplatelets to you after you’ve had:
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A heart attack
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A stroke
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Stents put into your heart arteries
Antiplatelets lower your risk of heart attack,stroke or blood clot in a stent.
Health risks of antiplatelets
Similar to anticoagulants, a health risk associated with antiplatelets is bleeding. A systematic review and meta-analysis found that although elderly patients who used antiplatelets suffer less bleeding than those who use oral anticoagulants, the risks of major bleeding are similar to that of oral anticoagulants, with the exception of intracranial bleeding (oral anticoagulants confer higher risk of intracranial bleeding).
Antiplatelet medicines
If you’ve experienced chest pain or stroke before, chances are you’re taking one or two of the below:
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Aspirin (e.g. Cardiprin®, Glycerin®) alone or in combination with any of the P2Y12 inhibitors:
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Clopidogrel (e.g. Plavix®) OR
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Ticagrelor (e.g. Brilinta®)
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Prasugrel (e.g. Effient®) - Prasugrel should not be prescribed if you have had a stroke or a transient ischemic attack (TIA).
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Why does the doctor make me take two antiplatelets instead of one?
In some cases, patients are taking a combination of antiplatelets called dual antiplatelet therapy (DAPT), which usually goes by: aspirin + any of the P2Y12 inhibitors. Studies have shown that DAPT is better than aspirin alone in preventing heart attack, stroke, cardiovascular death and blood clots caused by stents. The downside is that DAPT may also put you at a higher bleeding risk than using aspirin alone. However, you shouldn’t be too worried as your doctor will prescribe the best one for you based on your risk of blood clots and bleeding.
If you had a heart attack and a stent placed, or you are being treated with medical therapy (no stent, clot buster or surgery), in addition to aspirin, you should be treated with DAPT for 6-12 months, even longer in some cases. Some patients who undergo coronary artery bypass surgery may be treated with a P2Y12 inhibitor for a year after the bypass operation. After this, the P2Y12 inhibitor may be stopped, but the patient continues on aspirin. Your surgeon will discuss with you whether this treatment will be needed.
Overall, the duration of any DAPT treatment varies. Duration is very specifically made for the patient in conjunction with the doctor based on a number of factors, including the risk for bleeding, future heart attacks, strokes, clotting of the stent and death. Therefore, you should check with your doctor on the duration of your DAPT treatment.
Know these if you’re taking antiplatelets
Aspirin can cause gastric pain
One of the infamous side effects of aspirin is gastric pain. You may avoid this by taking aspirin with food or a full glass of water. If you’re taking other medications that may also cause gastric pain, such as NSAIDs painkillers, you’re even more likely to develop gastric pain. If you really have to take NSAIDs for your other medical conditions, switch to NSAIDs skin patch or gels, or consult your healthcare provider. Your doctor may also prescribe a gastric medication which name ends in “-prazole” (e.g. pantoprazole) to you.
Adhere to your treatment
Always follow your healthcare provider’s instructions on taking antiplatelets. Remember to take them the same time everyday, and refill the medications before it runs out.
Be careful of bleeding
Minimizing bleeding risk is even more important if you’re also taking anticoagulants at the same time. Medications such as NSAIDs may also increase your bleeding risk if you’re on aspirin or DAPT therapy.
Always check with your healthcare professional before starting new medicines and herbal products
Similar to what we’ve said about anticoagulants, you should always consult your healthcare provider before starting any new medicines, over-the-counter drugs, supplements, herbs and traditional medicines. This is because some of these products may affect how your antiplatelets work, which can result in higher bleeding risk. If you are having surgery or dental work, you may be asked to stop taking your antiplatelets temporarily. Otherwise, stop taking your antiplatelets only when your doctor asks you to.
A word from DOC2US
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References
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Antithrombotic Therapy - Hematology.org. Accessed April 27, 2021. https://www.hematology.org:443/about/history/50-years/antithrombotic-therapy
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Understanding Your Options When Taking Aspirin and Other Antiplatelet Drugs. www.heart.org. Accessed April 27, 2021. https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/understanding-your-options-when-taking-aspirin-and-other-antiplatelet-drugs
Cover image credit: Image by Arek Socha from Pixabay
