Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

It's easy to take medicines for granted. When we're sick, we may take a drug a few times a day to relieve our symptoms. Then, when we're feeling better, we go back to our daily routine.

But some medicines, such as blood thinner pills, require you to make lifestyle changes, such as taking them at the same time each day and making sure you don't injure yourself. These changes are important for you to stay safe and healthy.

Each year, nearly 2 million Americans start taking a blood thinner pill to prevent blood clots from forming in their bloodstream. Blood clots can lead to strokes, heart attacks, or other serious health conditions.

If your doctor thinks you are at risk for having a blood clot because you can't move around easily or you've had recent surgery or an injury, your doctor may put you on a blood thinner.

Blood thinners, also called anti-coagulants, work very well when they're taken correctly. Because they help your blood flow more easily, blood thinners lower your risk of developing dangerous blood clots.

But blood thinners also increase your chance of bleeding. When taking a blood thinner, you need to be careful when going about your daily routine. For example, you should take extra care to avoid getting cuts from sharp instruments, such as knives, tools, or other sharp objects. You must also carefully follow your doctor's instructions about your diet and how much of and how often to take your blood thinner.

Like learning to drive a car, taking blood thinners will require you to learn and practice several important steps so they become habits. To help patients remember these steps, my agency, the Agency for Healthcare Research and Quality (AHRQ), recently made a video (17.6 MB [Transcript]) and produced a . These tools will help you get the best results from your blood thinner.

The video describes the "BEST" way for you to remember important tips about blood thinners. BEST stands for:

  • Be careful. Use caution when doing activities that put you at risk for getting a cut or bruise. Even a small cut can bleed more than usual. Wear work gloves when working with tools, for example. Avoid high-risk sports or other dangerous activities. And if you do injure yourself, such as from a fall or hard bump to the head, call your doctor immediately.
  • Eat right. Your diet can affect how your blood thinner works. Do not eat or drink anything your doctor has told you to avoid. For example, your doctor may advise against eating or drinking items that are high in vitamin K (such as leafy green vegetables, vitamins, and herbal supplements) because they can interfere with some blood thinners. Most important, keep your diet consistent, both in the type and amount of foods you eat.
  • Stick to a routine. Take your blood thinner pills at the same time every day. You can have family members remind you, use a pillbox, or set the alarm on your watch. It's also important to talk to all of your doctors about all other medicines or supplements you take and to tell your doctors about any changes in your medicines. Also, talk to your doctor before taking aspirin because it also acts like a blood thinner.
  • Test regularly. Blood tests let your doctor know if you are getting too much or too little medicine. Your doctor may order an INR blood test. That stands for International Normalized Ratio, which is a calculation of the amount of time it takes for your blood to clot. Based on the results, your doctor may need to adjust your dose. It is very important that you have your blood checked regularly if your doctor tells you it's necessary. Home testing kits are available and covered by Medicare.

Taking a blood thinner does require you to make adjustments in your lifestyle. But just a few changes, followed each day, will ensure you're getting the benefits you need from this medicine. By following the BEST way and talking with your doctor, you'll help your blood thinner work well and safely for you.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Video
Staying Active and Healthy with Blood Thinners
http://www.healthcare411.ahrq.gov/videocast.aspx?id=555 (10 minutes, 26 seconds: 17.6 MB  [Transcript])

Agency for Healthcare Research and Quality
Blood Thinner Pills: Using Them Safely
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Your Guide to Preventing and Treating Blood Clots
http://www.ahrq.gov/consumer/bloodclots.htm

Current as of September 2009
Internet Citation: What You Need to Know about Blood Thinner Pills. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/091509.html