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A-Fib & Anticoagulants: Bleeding Risk If combined with OTC meds, Supplements

More than a third (33%) of people taking anticoagulants also take at least one nonprescription drug daily or most days of the week. This combination can cause dangerous side effects.

If you are taking an anticoagulant, such as Eliquis, Xarelto, Pradaxa or Savaysa, be aware that taking it along with some over-the-counter drugs and supplements can cause dangerous internal bleeding.

These over-the-counter drugs include painkillers such as aspirin, Advil (ibuprofen), and Tylenol (acetaminophen) and dietary supplements such as fish oil, turmeric, ginger and other herbs.

Internal Bleeding Risk: NOACs/DOACs Hard to Measure

The older anticoagulant, warfarin, required regular blood tests of INR (International Normalized Ratio) to measure how much warfarin was actually working in a patient’s blood to prevent a stroke.

But the newer anticoagulants (NOACs, DOACs), such as Eliquis, Xarelto, Pradaxa or Savaysa, aren’t normally measured by anticoagulation clinics or health care professionals using standardized tests such as INR. (The FDA, under pressure for new anticoagulants, approved the NOACs without there being any established or universally recognized method of determining their clot preventing effectiveness.)

Be aware that your doctor probably doesn’t test to see how much your NOAC is actually working in you. They hope it is, but doesn’t know for sure. Blood levels of your NOAC depends on factors such as how well or how poorly your kidneys are functioning.

Not all of your NOAC may actually be working for you. Pradaxa, for example, is 80% cleared by the kidneys. This means there may be lower anticoagulant levels in your blood stream, and a lot of your clot prevention is being flushed away by your kidneys. (Eliquis, Xarelto and Savaysa fare better with only 25%, 33% and 35% being cleared by the kidneys, respectively.)

Check With Your Doctor About Increased Internal Bleeding Risk

If you take an anticoagulant along with over-the counter drugs and supplements, ask your doctor which combinations to avoid. But be aware that many doctors are clueless about natural dietary supplements.

(Don’t ask them how effectively your NOAC is working in you. They probably don’t know and can’t easily test for that.)

References
• Tarn, D.M. et al.   Prevalence and Knowledge of Potential Interactions Between Over-the-Counter Products and Apixaban. The American Geriatrics Society, 2019. 68:155-162. https://agsjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.16193

• Tarn, Derjung M.  More Than A Third of Patients On Blood Thinners Take OTC Products That Can Cause Dangerous or Fatal Interactions. Thailand Medical News, Oct. 29, 2019. https://www.thailandmedical.news/news/more-than-a-third-of-patients-on-blood-thinners-take-otc-products-that-can-cause-dangerous-or-fatal-interactions-

• Tarn, Derjung M., Beware of blood thinner danger. Bottom Line Health, February 2020.

 

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