Blood Thinners

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction[edit | edit source]

Red blood cells trapped in a fibrin network

Blood thinners are medications used to treat and prevent blood clots. Blood thinners do not actually “thin” the blood. Instead, they help blood flow smoothly through blood vessels and work to reduce a person’s risk of forming blood clots. Blood clots are semi-solid clumps of red blood cells, platelets, fibrin (a type of protein), and other proteins.[1]

Clots that form in the arteries, veins and heart can lead to heart attacks, strokes and blockages that can cause other health problems[1].

Blood clots form through two important processes: the coagulation cascade and platelet activation. Blood thinners work by targeting steps in each of these processes.[2]

Blood Clot Formation[edit | edit source]

Showing Activated Platelets

Blood clots form through two important processes: the coagulation cascade and platelet activation. Blood thinners work by targeting steps in each of these processes.

  1. Coagulation cascade: damaged tissue sets off a cascade of events that activates several proteins in the blood (clotting factors). These proteins are activated through a series of steps that, ultimately, activates fibrin (an insoluble protein that is essential to clotting of blood, derived from fibrinogen by the action of thrombin).[3]
  2. Platelet Activation: A series of progressive, overlapping events, triggered by exposure of the platelets an injured tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable blood clot[4].

Indications[edit | edit source]

Blood Clot

Include, but not limited to:

  1. Deep vein thrombosis (DVT), a blood clot in the leg veins
  2. Pulmonary embolism (PE), a blood clot in the pulmonary blood vessels
  3. Acute coronary syndrome, a blood clot in the coronary arteries that causes heart attacks
  4. Prosthetic heart valves
  5. Left ventricular thrombus, a blood clot in the heart
  6. Acute limb ischemia, a blood clot in a leg artery
  7. Acute mesenteric ischemia, a blood clot in the artery feeding the bowel
  8. Atrial fibrillation, an irregular and unusually rapid heartbeat
  9. Hypercoagulable state, conditions that cause thick blood

Anticoagulants[edit | edit source]

Anticoagulation medications are used for treating red clots, eg deep vein thrombosis and pulmonary embolism, as well as preventing strokes in atrial fibrillation and mechanical heart valves. Examples of anticoagulants include:

  • Coumadin (warfarin)
  • Enoxaparin (low molecular weight heparin)
  • Factor X inhibitors, such as Eliquis (apixaban) and Xarelto (rivaroxaban)
  • Direct thrombin inhibitors, such as Acova (argatroban), Angiomax (bivalirudin), and Pradaxa (dabigatran)
  • Tissue plasminogen activators such as Actilyse (alteplase), TNKase (tenecteplase), and Retavase (reteplase)

Antiplatelets[edit | edit source]

Antiplatelets can be classified based on the mechanism of action as follows:

  • Platelet aggregation inhibitors such as; Aspirin and related cyclooxygenase inhibitors; Oral thienopyridines such as clopidogrel, ticagrelor, ticlopidine, clopidogrel and prasugrel
  • Glycoprotein platelet inhibitors (e.g., abciximab, eptifibatide, tirofiban)
  • Protease-activated receptor-1 antagonists (e.g., vorapaxar)
  • Miscellaneous (e.g., dipyridamole - a nucleoside transport inhibitor and phosphodiesterase type 3 (PDE3) inhibitor, cilostazol - also a PDE3 inhibitor)[5]

Risks[edit | edit source]

Risk: Bleeding

The main side effect of blood thinners is bleeding. People who take blood thinners will notice that a cut or nick takes longer to stop bleeding and that they bruise more easily. But serious bleeding, such as bleeding in the gastrointestinal tract or brain, can occur. These bleeds can be life-threatening[2].

Physiotherapy implications[edit | edit source]

Advise individuals taking anticoagulants to avoid high-impact or injury-prone activities, such as hockey, soccer, skiing or football.

Educate clients of the importance of staying active to keep your heart and vascular system as healthy as possible.

Seek care immediately if client has a major fall.

References[edit | edit source]

  1. 1.0 1.1 Drug watch Blood thinners Available: (accessed 10.4.2022)
  2. 2.0 2.1 Very well health Blood Thinners Available:
  3. The free dictionary Fibrin Available: 10.4.2022)
  4. Definitions Platelet Activation Available; (accessed 10.4.2022)
  5. Iqbal AM, Lopez RA, Hai O. Antiplatelet medications. InStatPearls [Internet] 2020 Dec 7. StatPearls Publishing. Available: (accessed 10.4.2022)