Welcome to Part 2 of Everything You Need to Know About Blood Clots. In Part 1, we took a look at how you can tell if you have a blood clot. What are the signs that you are looking for? What should you do if you think you have a blood clot? For that info and more check out Part 1.
In Part 2, let’s look at what happens once you know you have a blood clot. How do we get rid of it? How do you prevent this from happening again? Read on…
So you have a blood clot! What’s next?
Our bodies are amazing and do a terrific job coping with trauma and insult. Your body will naturally break down a clot on its own. But medications can help. If you have a clot, you will likely be started on a ‘blood thinner’ (anticoagulant). An anticoagulant makes your blood less likely to clot and prevents another clot from forming. There are a couple different options:
1) Low molecular weight heparin (e.g. enoxaparin (lovenox), tinzaparin (Innohep))
These medications are injections with a small needle that goes just below the skin (subcutaneous). They come in a prepared, one time use syringe so they are super easy to inject on your own. But ek! This still sounds scary. Don’t worry – it’s easy - you can do it!
For more information on how to inject go here
Of course there are side effects. Because the medication is thinning the blood, you are more likely to have a bleed. This might be something simple like your gums bleed a bit more when you floss or you bruise easier. But it can mean more serious bleeds like blood in your urine or in your poop (which can be bright or dark red). For situations like this or if you’re bleeding for a long time (from anywhere) – then you need to go to the emergency room. So I mentioned bruising so let’s go back to that for a moment. You will likely find bruising where you inject the medication. This is harmless but annoying. To minimize bruising, try not to rub or press on the place you injected the medications.
2) Newer anticoagulants (rivaroxaban (Xarelto), dabigatran (Pradaxa), or apixaban (Eliquis))
You might be suggested one of the newer anticoagulants. But new isn’t always better – there are pros and cons to these drugs. A clear pro – you swallow these pills instead of injecting. A con – if you have an uncontrolled bleed while on these drugs, there’s no way to reverse it (e.g. antidote). There is also less scientific literature supporting using these drugs in people with cancer. As we gain more experience, we will learn more but for now, low molecular weight heparin (above) are the go to drug in cancer fighters.
3) Warfarin (Coumadin)
From new to very old – warfarin. Warfarin isn’t often used in people with cancer. Warfarin dosing is titrated to your specific body and habits to hit a desired blood level (INR 2-3). When you are going through treatment, it is difficult to keep things consistent to obtain this blood level. You are receiving intermittent chemotherapy, some weeks you are feeling well and eating and some weeks – not so much. Because of these variations, its difficult to maintain that desired level of warfarin in your body. It just doesn’t work very well to provide you with the consistent blood thinner qualities that you need.
Depending on the type of clot you have, you could be on one of these medications anywhere from 3 months to indefinitely.
Those are a few of your options for blood thinners which will offer you protection to prevent another blood clot.
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