Heart Medications Archive

Q. One year ago when I was flying home from a ski trip, my legs were cramped due to luggage under my seat. To make a long story short, I was soon found to have a blood clot in my right calf and a small blood clot in my lungs. I was treated with warfarin for three months and did just fine. Now I want to take a long plane trip to South America, and am wondering whether I need to do anything to reduce my risk of another blood clot.

A. This is a tough one. For anyone taking a long plane flight, I advise drinking plenty of fluids and getting up to walk around every hour or so. That might be enough to reduce your risk of blood clots. I would feel more comfortable with that approach if I knew you had had a clear cause for your blood clots back then, such as trauma to your leg.

Q. I recently developed atrial fibrillation, and I wonder whether I need to take an anticoagulant. I am 81 years old, active, and don't really notice when I am in atrial fibrillation. I was taking my pulse every now and then and found it to be irregular. My doctor said I was going back and forth between a normal heart rhythm and atrial fibrillation. I am in normal (sinus) rhythm now, but he says I should be on warfarin because I have high blood pressure. What do you think?

A. Your physician's recommendation of warfarin probably reflects his conclusion that the risks of treating you with warfarin are worthwhile, because this blood-thinning drug can reduce your risk of a stroke. He may be using the CHADS2 scoring system, which is a simple way of estimating a person's risk of a stroke. The letters in CHADS2 stand for congestive heart failure, hypertension, age 75 years or more, diabetes mellitus, and prior stroke or transient ischemic attack. The first four factors earn you one point, and the last one earns you two points.

There's no definitive proof this combination is dangerous.

If a stent was inserted in your coronary arteries to improve blood flow, you may be taking clopidogrel (Plavix) and aspirin to prevent a blood clot from forming inside the stent. This combination of medications has been shown to reduce the risk of a fatal or nonfatal heart attack. As a result, clopidogrel has become one of most commonly prescribed medications in the United States.

If you have tried to quit smoking, you know how difficult it is. Nicotine is so addictive that smokers often must try multiple smoking-cessation aids and combinations of aids before they are able to break the habit—a critical step for people with heart disease.

Many people have been successful with a drug called varenicline (Chantix), which acts directly on the brain to interfere with nicotine dependence. Doctors recently became concerned when an analysis of existing studies on varenicline published in the Canadian Medical Association Journal (CAMJ) concluded that the drug posed a significant risk of serious cardiovascular events.

Interactions may increase the risk of internal bleeding.

If you have atrial fibrillation, narrowed coronary arteries, a history of blood clots in the legs or lungs, or have undergone valve surgery or stent placement, there's a good chance you take warfarin (Coumadin). An anticoagulant ("blood thinner"), warfarin reduces blood's ability to clot. By preventing blood clots from forming in the brain, heart, legs, and lungs, warfarin lowers the risk of stroke, heart attack, and death.

Many antibiotics and related medications, including azole antifungal agents, heighten warfarin's blood-thinning ability and raise the risk of internal bleeding. Some antibiotics, such as rifampin, decrease warfarin's ability to "thin" the blood, increasing the risk a blood clot will form. People taking warfarin and antibiotics must be monitored closely. That's why if you are prescribed an antibiotic to treat or prevent an infection, you should immediately tell the clinician who manages your warfarin.

ACE inhibitors beat ARBs hands-down for survival benefit.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are mainstays of treatment for heart failure. Both help the heart pump more effectively by affecting the renin-angiotensin-aldosterone system (RAAS), which governs blood pressure. So it seems strange that no specific comparison of their impact on death from high blood pressure (hypertension) has ever been performed until recently.

What you need to know about these cholesterol-lowering medicines.

If you've been having trouble controlling your cholesterol levels, your doctor may have recommended that you take a statin drug. Statins lower LDL cholesterol—the so-called "unhealthy" or "bad" cholesterol because it helps to form the artery-clogging plaques that can lead to heart disease.

Most people taking statins are accustomed to having routine blood tests to watch for uncommon but serious liver-related side effects. But the rare cases of liver damage from statins aren't accurately predicted by routine blood testing. So, in March, the FDA recommended blood tests for liver function only when a person first starts taking a statin or if symptoms arise.

At the same time, the FDA strengthened label warnings on statins for two other possible side effects: increased blood sugar and temporary memory or cognitive lapses. The blood sugar concerns are supported by study data, while hard data on memory effects are still being collected. The risk of side effects seems to rise with increasing statin dose, and side effects usually stop when the drug is discontinued.

Less frequent testing or home monitoring may be options.

Despite the recent FDA approval of easier-to-use anticlotting drugs, millions of Americans continue to take warfarin (Coumadin, Jantoven, generic) to prevent dangerous blood clots. The most worrisome clots—which can cause a stroke or potentially fatal shutdown of lung function—arise from atrial fibrillation, deep-vein thrombosis, or the presence of an artificial heart valve.

Those arising from atherosclerosis and atrial fibrillation can be very dangerous.

When you poke yourself on a thorn while gardening or get a paper cut at the office, your body marshals the forces needed to stop the flow of blood and repair the damage. If it weren't for the blood's ability to clot (form a thrombus, in medicalese), even these minor scrapes of daily living could cause us to bleed uncontrollably. These healing clots also form inside the body at sites of blood vessel injuries. Normally, when the clot's job is done, it dissolves away.