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For decades, the blood thinner of choice was warfarin. Patients needed regular blood tests to constantly monitor and adjust the dose. (Justine Goode \/ NBC News; Getty Images)<\/p>\n
(Justine Goode)<\/p>\n
Larry Bordeaux, 65, has been on blood thinners since 2010, after he started developing deadly clots following an operation.<\/p>\n
He credits the drugs with saving his life. If he stops taking them for several days \u2014 which he must sometimes do before certain medical procedures \u2014 clots develop quickly.<\/p>\n
Still, Bordeaux, of Havelock, North Carolina, knows that being on blood thinners is a double-edged sword: They put him at a heightened risk of serious, uncontrolled bleeding. Since he started taking them, Bordeaux has experienced complications ranging from a serious hematoma \u2014 in which a pool of blood forms outside of blood vessels \u2014 to gastrointestinal bleeding.<\/p>\n
\u201cEven with something like a simple fall, if the blood thinner [dose] is not correct, I could bleed out,\u201d said Bordeaux, who has since become involved with the National Blood Clot Alliance, a nonprofit organization that aims to reduce deaths and complications from blood clots, as well as prevent adverse events linked to blood thinners.<\/p>\n
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Larry Bordeaux has taken a blood thinner since 2010. (Courtesy Larry Bordeaux)<\/p>\n
(Courtesy Larry Bordeaux)<\/p>\n
Bordeaux is just one of more than 8 million people in the U.S.<\/a> who take blood thinners, also called anticoagulants. Many, like him, are prescribed the drugs after they develop clots following surgery. Others take blood thinners because of an age-related heart rhythm disorder called atrial fibrillation<\/a>, which makes clots likelier to form.<\/p>\n Blood clotting, of course, is an essential process in the body to stop bleeds. But when blood clots form too readily, it can block blood flow, leading to embolisms, heart attacks and stroke<\/a>. Blood thinners work by interfering with the body\u2019s normal blood clotting process. At the same time, the drugs are also responsible for a staggering number of unintended bleeding events, sending hundreds of thousands of older people to the hospital every year. A study in the American Journal of Medicine<\/a> estimates that that costs the health care system more than $2.5 billion every year.<\/p>\n \u201cWhile they prevent stroke and embolism, they do cause bleeding,\u201d said Dr. Samin Sharma, director of the Cardiovascular Clinical Institute at Mount Sinai Fuster Heart Hospital in New York City. \u201cStudies have shown that they decrease the [risk of an] ischemic stroke, but the [risk of a] hemorrhage stroke goes slightly up.\u201d (Ischemic strokes are caused by blockages, while hemorrhagic strokes are caused by bleeds.)<\/p>\n Even President Donald Trump has mentioned the risks linked to blood thinners<\/a>, in particular aspirin, which he takes daily. \u201cI take the larger one, but I\u2019ve done it for years, and what it does do is it causes bruising,\u201d he told The Wall Street Journal<\/a> at the end of last year.<\/p>\n According to Dr. Pieter Cohen, an associate professor of medicine at Harvard University, who carried out a recent study<\/a> on emergency room visits due to blood thinners, the most common issue is bleeding in the stomach or the wider GI tract.<\/p>\n Bordeaux developed a large hematoma after a bike crash. (Courtesy Larry Bordeaux)<\/p>\n (Courtesy Larry Bordeaux)<\/p>\n \u201cA bunch of those people need to be hospitalized to stabilize the situation, or they may need a transfusion,\u201d Cohen said. \u201cSo that can be very serious. A very swift, massive GI bleed that cannot be stabilized can lead to disability or death.\u201d<\/p>\n People taking anticoagulants can also experience serious bleeds<\/a> from small cuts or grazes, uncontrolled nosebleeds, blood in the urine and, more rarely, brain hemorrhages or bleeding in the lungs.<\/p>\n \u201cIf you have a source of blood loss, anticoagulants increase the likelihood that you will lose more blood, that you will require a transfusion and that you\u2019ll have a worse outcome,\u201d said Arthur Allen, a clinical pharmacist and president-elect of the Anticoagulation Forum, which is working to establish better ways of reducing risk of serious bleeds.<\/p>\n Yet advocates feel that many patients and their families are not sufficiently informed of the risks related to blood thinners.<\/p>\n \u201cBleeding events aren\u2019t rare edge cases; they happen every day,\u201d said Leslie Lake, president of the National Blood Clot Alliance. \u201cThe staggering part is not just the numbers, but how quietly these events occur, often dismissed as complications rather than preventable harms.\u201d<\/p>\n Many of those harms are preventable: Research suggests that almost half of all adverse events<\/a> related to such drugs could be avoided.<\/p>\n So what can be done better?<\/p>\n A new class of blood thinners<\/p>\n Blood thinner harm was not supposed to still be a major issue. For nearly 60 years, the drug of choice was warfarin, which was originally developed as a rat poison<\/a>. The major limitation of warfarin is that it does not work uniformly, and patients need regular blood tests to constantly monitor and adjust the dose.<\/p>\n \u201cWarfarin was a very, very tricky drug,\u201d Allen said. \u201cThere was a constant balancing act that required getting a blood test done anywhere from once a week to once a month.\u201d<\/p>\n In 2010, a new class of blood thinners arrived, known as direct oral anticoagulants, or DOACs. Four of them are available in the U.S. \u2014 apixaban (sold under the brand name Eliquis), dabigatran (brand name Pradaxa), edoxaban (Savaysa) and rivaroxaban (Xarelto) \u2014 and clinical trials have shown them to be safer and more consistent than warfarin.<\/p>\n Yet in the real world, that has not translated to improved safety. More than a decade since the new class of blood thinners were introduced, about 300,000 people in the U.S. taking anticoagulants still end up in the emergency department every year with bleeds, and the proportion being hospitalized on the newer drugs remains similar to that of warfarin, according to a 2024 study<\/a>.<\/p>\n Why? Part of the promise of the newer drugs was that they did not require the same degree of monitoring as warfarin. Because of that, Allen said he is concerned that the new generation of blood thinners is sometimes prescribed without sufficient oversight. In particular, the risk of bleeds can be aggravated when blood thinners are prescribed for too long or through overmedication, with one particularly pertinent example being when blood thinners are given alongside<\/a> antiplatelet drugs \u2014 another class of anti-clotting medications that are commonly prescribed after people have experienced cardiac events.<\/p>\n \u201cThere\u2019s a suggestion that a third of patients who are on anticoagulants are also on antiplatelet agents, and often inappropriately,\u201d Allen said. \u201cIn reality, antiplatelets are rarely indicated in combination with anticoagulants, and when they are, it\u2019s usually [supposed to be] time-limited.\u201d<\/p>\n In a statement to NBC News, Daiichi Sankyo, which makes Savaysa, said that the drug is used to reduce the risk of stroke and clots but added that anticoagulants can increase the risk of serious bleeding. The statement also noted that patients\u2019 kidney function should be checked before they start treatment.<\/p>\n Johnson & Johnson, which makes Xarelto, said in a statement that the drug reduces risk of clots and stroke for adults with certain medical conditions, but they encourage patients to speak with their health care providers to understand the benefits and risks of any medication. Bristol Myers Squibb and Boehringer Ingelheim, makers of Eliquis and Pradaxa, respectively, did not respond to requests for comment, but both websites mention the risk of bleeding from the drugs.<\/p>\n Another issue is patients taking blood thinners alongside common anti-inflammatories such as aspirin, which also acts as a blood thinner and is also known to increase bleeding risk. A study in Michigan<\/a> found that 1 in every 3 patients taking blood thinners for atrial fibrillation or venous thromboembolism \u2014 a serious condition where clots form in deep veins \u2014 were also regularly taking aspirin.<\/p>\n \u201cAspirin is very readily available over the counter, and if the patient hasn\u2019t been educated enough, that can lead to serious adverse outcomes,\u201d said Dr. Sabine von Preyss-Friedman, a geriatric specialist and president of the Post-Acute and Long-Term Care Medical Association.<\/p>\n Experts say another common and often overlooked limitation of anticoagulants is that even with the newer generation of the drugs, doctors need to take care to prescribe the appropriate drug and dose for a patient. If the original dose is too high or it is not adjusted over time \u2014 to account for changes in kidney function, weight and patients\u2019 increased risk of falling as they get older \u2014 the risk of serious or fatal bleeding events increases.<\/p>\n Cohen said that in prescribing apixaban, the most commonly used blood thinner in the U.S, the typical dose is 5 milligrams twice daily but that for people over 80, the dose should be half of that.<\/p>\n Weighing the risks<\/p>\n Can more bleeds be prevented? While hematologists and vascular medicine doctors have the most expertise managing blood thinners, the ubiquitous nature of the medications means they are prescribed by everyone from primary care physicians to cardiologists. Allen said dosing errors<\/a> could be avoided by training more vascular medicine doctors.<\/p>\n Sharma said that when the bleeding risk is deemed too high, it is better not to prescribe such drugs at all.<\/p>\n \u201cSometimes you have to make a decision,\u201d he said. \u201cIf you think there\u2019s a high chance of bleeding and the stroke risk is low to intermediate, we can make a decision that giving anticoagulants will be more risky.\u201d<\/p>\n These are not always easy choices to make, and anticoagulation experts like Allen are wary of creating a world where doctors are too scared to prescribe blood thinners, as that would be likely to lead to more strokes and even more preventable harm.<\/p>\n Instead, some hospitals are turning toward predictive models to help doctors weigh patients\u2019 risk of bleeding versus their risk of stroke.<\/p>\n Toby Trujillo, a professor in the clinical pharmacy department at the University of Colorado Anschutz, said emerging AI tools could help doctors identify the correct dose for a patient, as well as prioritize which patients need to be seen by specialists.<\/p>\n \u201cSome health systems across the country have worked with their electronic health record system to develop what is known as a \u2018DOACX Dashboard<\/a>,\u2019\u201d Trujillo said. \u201cOnce it is available, it will flag patients on DOAC therapy that are in need of a specialist. The dashboard may identify patients who may have started on a new medication that interacts with a DOAC, patients who have had a change in their kidney function or who have been prescribed an inappropriate dose. This can help focus the expertise of specialists to patients who need them.\u201d<\/p>\n Newer treatment possibilities are also on the horizon. Experts are studying whether ablation \u2014 a surgical procedure that uses either heat or cold energy to create tiny scars in the heart to block the faulty electrical signals driving irregular heartbeats \u2014 can be a better long-term solution for atrial fibrillation, allowing patients to stop taking blood thinners.<\/p>\n![\"Bordeaux](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/02\/71ce3efc5745a97d8ff9ab8ddb2bbaf1.jpeg\"\/)
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