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Risks vs. benefits; Akron General joins study of blood thinners

By Tracy Wheeler
Beacon Journal medical writer

Published on Tuesday, Jul 01, 2008

Even when used as intended, blood thinners can be risky.

The drugs are essential in treating patients who have had heart attacks, strokes or blood clots. But their ability to reduce clotting brings risks, too.

''You're always walking a fine line of how much do you give for it to be effective,'' said Joe Snoke, assistant director of clinical services in Akron General Medical Center's pharmacy department. ''If a little bit is good, if you double it, is it going to be better?''

To help hospitals find the best ways to use and monitor blood thinners, Akron General — along with Aultman Hospital in Canton and 43 other hospitals across Ohio — is participating in a project with the Ohio Patient Safety Institute to ''reduce life-threatening complications'' of these indispensable, but dangerous, drugs.

Blood thinners, or anticoagulants, don't dissolve blood clots, but, rather, prevent new clots from forming or an existing clot from growing.

Sometimes, they are used to treat patients after a heart attack or stroke. Sometimes, they are used as a preventative — in people with atrial fibrillation (a rapid or off-rhythm heartbeat) to prevent strokes, which are caused by a clot blocking blood flow to the brain; or in people with deep vein thrombosis (a blood clot in the leg) to prevent pulmonary embolism, which is caused by a clot blocking blood flow to the lungs.

Heparin and warfarin, also known under the brand name Coumadin, are the most commonly prescribed blood thinners.

Nearly 4 million Americans took warfarin in 2005, according to the latest data from the Agency for Healthcare Research and Quality (AHRQ). Yet warfarin was responsible for more emergency room visits than any drug other than insulin, according to the U.S. Food and Drug Administration.

''Warfarin is an effective drug, but it must be used with special care to avoid dangerous bleeding,'' said Dr. Carolyn Clancy, AHRQ's director.

''Individuals respond differently to warfarin, so the dosage must be personalized to each patient, and it is necessary for patients and clinicians alike to be aware of the factors that make for safe use of the drug.''

Not surprisingly, improper use of blood thinners creates bleeding problems. Cuts and scratches may bleed longer than usual, but the real danger is unseen bleeding, such as in the stomach or near the kidneys, Snoke said.

''In the hospital, we're more concerned with bleeding that we don't necessarily see right away. Bleeding that's not apparent when looking at patients,'' Snoke said. ''Part of this whole project is to make sure you have monitoring in place, testing in place, so that if you have problems with one of these drugs you catch it quickly.''

Medications have risks

The goal of the statewide initiative is for hospitals to examine their own practices, then share those protocols that have the best results — including use of blood thinners in the hospital, as well as proper monitoring after patients are discharged.

''Being a part of this collaborative effort allows hospitals to share ideas and resources to benefit everyone,'' said Dr. Lori Mertes, medical director of quality at Aultman Hospital.

Deaths and illnesses because of blood thinners have made headlines recently.

According to the FDA, heparin has been linked to 248 deaths in the United States since January 2007. Of those, 149 were connected to contaminated batches that were later recalled.

And late last year, the twin newborns of actor Dennis Quaid spent 11 days in intensive care after being given 1,000 times the recommended dose of heparin. Their blood ''basically turned to the consistency of water,'' causing massive bleeding, he told Congress in May. Although the long-term effects of the overdoses are unknown, he said, the babies seem to be doing fine now.

It's important that patients understand the risks that come with blood thinners, Snoke said. But it's also important that they understand that ''these are very useful medications we absolutely have to have.''

Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.

 

Even when used as intended, blood thinners can be risky.

Get the full article here.


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