The news stories all start out the same: People with atrial fibrillation (afib)—a heart rhythm disorder—may have a higher risk of developing dementia, and it may be due to a widely-used afib medication. What they don’t say (unless it’s buried deep in the middle of the story where no one will read it) is that this “afib medication” isn’t just used for atrial fibrillation.
It’s an incredibly common drug. It’s used to prevent strokes. It’s used both to treat heart attacks and to prevent them. It’s used for atrial fibrillation. It’s used to prevent blood clots after hip or knee replacement surgery. It’s used to treat deep vein thrombosis…the list goes on and on. It’s sold under the brand names Jantoven and Coumadin. The drug is warfarin, a blood thinner that till recently was the only game in town for many conditions.
Legitimate concern or just a push for newer, pricier drugs?
The scary news stories are based on a pretty shaky study. Of course, you wouldn’t know that from reading them. Most fail to tell you some of the most important facts about the study in question:
- It was a “retrospective” study, which means researchers looked at people’s health records and drew conclusions long after the fact. It wasn’t placebo-controlled. It wasn’t randomized. It was simply a retroactive look at medical records. If this were a study of something “alternative” it would be dismissed as irrelevant.
- The people studied were taking warfarin for a variety of reasons, not just for atrial fibrillation.
- Most of the people studied were already aged and in poor health, which means there could be any number of other factors are at play.
- The rate of dementia overall was about equal to the rate in the general population—healthy, sick, and otherwise.
- The dementia risk seems to go hand-in-hand with atrial fibrillation, not warfarin use.
That last bullet point is important. Because most of the news stories suggest—or outright recommend—that people should take newer, pricier blood thinners to avoid this alleged risk. But that’s not what the study said.
This study looked at the medical records of some 10,000 people taking warfarin. Some were taking it for atrial fibrillation and some were taking it to prevent blood clots from other causes. But all were taking warfarin. Again, this is an important thing to note. We’re not looking at a study that weighed the difference between people taking warfarin and people taking a sugar pill, or even taking a different kind of blood thinner. No. Everyone in the study was taking warfarin for one reason or another.
The study authors found that about 6% of the people with afib developed dementia over six to eight years. Now, we’re not given an age range for the people in the study, but 6% is right in line with the percentage of the general population who has dementia. Interestingly, less than 2% of those taking warfarin for other reasons ended up with dementia. This suggests that if there is a higher dementia risk—and again, unless the bulk of the study subjects were under 65, six percent is not an overly high rate—it may be related to afib, not warfarin use.
And in fact, cardiologists who were interviewed do make this comment. They speculate that atrial fibrillation may contribute to “micro clots” in the brain, which in turn makes dementia more likely. Yet every single news story starts out saying “this drug might cause dementia” and most go on to mention “alternatives” to warfarin.
Big Pharma would love to see warfarin go the way of the dinosaur. Though it’s still the go-to drug of choice for doctors prescribing a blood thinner, since the brand name varieties have gone off-patent this drug has become very cheap. And though there are newer blood thinners out there, they aren’t any safer or more effective, and doctors still tend to recommend warfarin when they reach for the prescription pad. Are the scary headlines an effort to frighten people into asking for the newer drugs? They just might be.
ALL prescription blood thinners are dangerous
Don’t be taken in by the scary headlines. Warfarin is a dangerous drug, it’s true. But all prescription blood thinners are dangerous. All have a long list of side effects. Not surprisingly the most common of these is bleeding, and it can be serious. Blood thinners can also affect your liver. They can cause kidney problems. They commonly cause gastrointestinal issues. And there are many more possible side effects.
Warfarin, in spite of its dangers, appears to have somewhat fewer of these than the newer drugs. You are more likely to have an episode of bleeding with it than with the new kids on the block. However, bleeding from the new drugs is much, much harder to control. This is one of the reasons that warfarin continues to be popular with doctors.
Are there any natural blood thinners out there? There are, and I’ll tell you about them in a moment. But first I’d like to say this: if you’re on a blood thinner and you want to try a natural alternative, this is one time you really should talk to your doctor. He may not approve. In fact he probably won’t. He’ll probably do his best to discourage you, so be prepared. But you need to have the conversation so that he knows exactly what you’re doing and can adjust whatever medication you’re taking accordingly—so that you don’t either develop clots or have a serious bout of bleeding.
So what are your options for natural blood thinners? One of the most effective appears to be fish oil. The omega-3 fatty acids in fish oil make the platelets in blood less prone to clumping. In fact, fish oil is one of the supplements warfarin users are advised not to take, precisely because they do have a blood thinning effect. And of course omega-3s have a long list of other cardiovascular benefits. Recommended dosage is 2-3 grams per day.
Garlic has also shown powerful anti-platelet activity. Dosage is 1-2 grams daily, and it can be found in odorless capsule form in any health food store.
Last but not least, if you’re on blood thinners—whether prescription or natural—you should watch your intake of vitamin K. High levels of vitamin K cause blood to clot more easily and can counteract the effect of blood thinners. Foods highest in vitamin K include most leafy greens, especially collard greens, kale, spinach, mustard greens, and turnip greens.