Four questions to ask your doctor about blood thinners
By ShareMD Connect
Most people living with AFib will be presented with medication as a first line of treatment. You’ll probably start multiple medications to control your heart rate and rhythm, but you’re also likely to be prescribed a blood thinner like Warfarin or Eliquis to reduce your risk of stroke.
Blood thinners can save lives. They make you less likely to form a clot and have a stroke - which for people living with AFib can be twice as deadly and disabling than those who don’t have AFib. But blood thinners come with serious risks and major lifestyle changes.
You should expect to have a conversation with your doctor before starting blood thinners to make sure they’re right for you. If that doesn’t happen, but your provider wants you to take blood thinners anyway, you should question the decision. Even if you’ve already started taking these medications, asking questions and learning more about other options is okay.
Here are four questions to help start the conversation with your doctor about blood thinners.
Question 1: What’s my stroke risk right now?
Blood thinners are used to reduce the risk of stroke and, when used correctly, reduce your chance of stroke by 64%. But some people are at a higher risk of having a stroke than others.
If your stroke risk is high, then blood thinners could save your life. But if it’s low, they may not be necessary.
There is a tool that doctors use to calculate your stroke risk called the CHADS2 score. This tool looks at the factors that make it more or less likely that you’ll have a stroke in the next year. If you have a low score, blood thinners may not be recommended. If you have a high score, they may be necessary.
If your doctor is recommending blood thinners it’s a good idea to ask them what your score is. If your score is low, but blood thinners are still recommended, ask questions until you understand the risks and benefits of taking this medication.
If your doctor didn’t use the CHADS2 scoring system - or can’t answer your questions about your stroke risk - it’s a good idea to seek a second opinion.
Question 2: What’s my bleeding risk
The biggest risk of taking blood thinners is that they make it easier for your body to bleed. If you fall or injure yourself you could be at risk for a major bleeding event, which requires hospitalization and does have a chance of death.
It’s hard for doctors to predict a person’s risk of bleeding. But similar to the scoring system used for assessing stroke risk, there’s a scoring system to help your doctor assess your risk of major bleeding.
The most commonly used scoring system is called the HAS-BLED score. It looks at about nine different factors that could impact your chance of bleeding and assigns points to each factor. If you have a high score, you have a high risk of bleeding. If you have a low score, you have a low risk of bleeding.
It’s a good idea to ask your doctor what your HAS-BLED score is so that you understand your risk of having a major bleeding event.
If your risk is high, but your doctor is still recommending blood thinners, ask questions until you understand the risks vs. benefits of taking blood thinners. However, keep in mind that for most people, strokes are much more serious than bleeding events.
Question 3: Do I have to change my lifestyle once I’m on blood thinners?
Blood thinners often mean lifestyle changes. You may have to change your diet, stop participating in sports or high-impact activities, plan to have bloodwork done every 2-3 weeks, and prepare to live with side effects.
If you work in a physically-demanding or risky occupation like construction or manufacturing, blood thinners may not be an option for you because you won’t be able to make the necessary lifestyle changes to keep you safe.
It’s important to talk to your doctor about your current lifestyle and ask questions to understand what will need to change.
Changing your lifestyle may mean that you start to have anxiety and fear around doing activities that could cause bleeding. This can make some people become sedentary and start to isolate themselves from the world. The mental impact of taking blood thinners can be very serious and is something to talk to your doctor about ahead of time so that you have tools to cope.
Question 4: What’s the plan if the side effects of blood thinners become too hard to live with?
For some people, the side effects that come with blood thinners are too hard to live with. They can make people feel miserable and leave them unable to do anything other than try to cope with symptoms.
There is a long list of side effects, but the most common are:
- Nuisance bleeding (like nose bleeds, gums bleeding from brushing your teeth, or getting a cut that won’t stop bleeding)
- Skin rashes
- Anemia
- Severe stomach pain and nausea
- Severe headaches
- Fatigue and weakness
- Dizziness
- Shortness of breath
- Changes in urine and stool
- Vomiting or coughing up blood
Unfortunately, many people start blood thinners unaware of how life-changing these side effects can be. Then, once they become too hard to live with, they report that their doctor doesn’t take their concerns seriously.
It’s a good idea to ask your doctor, “what’s the plan if I have serious side effects?” early on. If maintaining your quality of life is important to you, make that clear with your provider.
If you’re not satisfied with your doctor’s answer, it’s a good idea to get a second opinion.
Taking blood thinners is a major treatment decision that should be made jointly between you and your doctor. You can only make an educated decision if you have all the information - that’s why it’s important to ask your doctor these four questions and any others that you think are important.