Lowering Your Risk for a Heart Attack: Are Blood Thinners Right for You?

This article is for people who have heart disease and want to know how to lower their risk for a heart attack or for anyone who is interested in learning more about those topics. The goal of this patient education activity is to learn about treatment options for heart disease that can help you lower your risk for a heart attack.

You will learn about:

• What causes a heart attack

• Risk factors that increase your chance for a heart attack

• Treatment options for heart disease that can help prevent a heart attack, including blood thinners

• How to know when you should get emergency help

• Tips to keep your heart healthy

• Questions to ask your healthcare provider

If your healthcare provider told you that you have heart disease, that means your heart is not getting enough blood and oxygen.

The main reasons for why your heart isn't getting enough blood are:

• Cholesterol builds up as plaque and decreases blood flow to your heart by making your arteries narrower, or it can block your artery

• Plaque can break off and cause your body to form a blood clot (which is a clump of plaque, platelets, and red blood cells); a blood clot can block your artery and cut off blood flow to your heart

Blockage or less blood flow to your heart can cause chest pain, a heart attack, or sudden death.

Both men and women with heart disease are at risk for having a heart attack or death. Even if you are being treated for heart disease you can still be at high risk, especially if you have these risk factors:

• Age 65 years or older

• Current smoker

• Diabetes

• Heart failure

• Kidney disease

• Peripheral artery disease (when plaque builds up in blood vessels in your arms and legs)

• High cholesterol (even with treatment)

• Already had a heart attack or stroke

• Already had heart surgery

• Heart disease runs in your family

• You get little or no physical activity

To prevent a heart attack, you have to treat your heart disease and risk factors. To start, you will be taking medicines that lower your cholesterol and blood pressure to reduce stress on your heart.

To prevent blood clots from forming and blocking blood flow to your heart, your healthcare provider may ask you to take blood thinners. Blood thinners include antiplatelet agents and a new treatment option for people with heart disease called an anticoagulant, or "NOAC." It is important to talk to your healthcare provider about how these medicines work and their safety.

There are also lifesaving surgical and nonsurgical procedures that improve blood flow to your heart by rerouting blood flow, opening your artery, or removing the blockage:

• Coronary artery bypass graft surgery (CABG): connects blood vessels from another part of your body to blood vessels around the blocked artery in your heart

• Angioplasty: a small balloon is inflated inside your blocked artery to open it up

• Stent implantation: during angioplasty, a thin mesh tube, or "stent," is placed to permanently keep your artery open

• Atherectomy: an invasive procedure that removes plaque that's blocking your artery

You will still need to take medicines to lower your risk for a heart attack.

Antiplatelet medicines are a type of blood thinner that have been around for a long time to treat people with heart disease. These medicines stop platelets in your blood from sticking to plaque and forming a clot.

To prevent a heart attack, some people take aspirin, but only after they talked to their healthcare provider about it. Other people who have had a stent placed or a CABG procedure, may take aspirin and another antiplatelet medicine that is stronger than aspirin, like clopidogrel, prasugrel, or ticagrelor.

Antiplatelet Agents Used to Treat Heart Disease
Aspirin Clopidogrel (Plavix®) Prasugrel (Effient®) Ticagrelor (Brilinta®)

Anticoagulants are blood thinners that are a bit newer than antiplatelet agents. A NOAC is a type of anticoagulant that slows down your body's process of making blood clots and stop red blood cells from forming a clot in your veins.

NOACs have been used to prevent blood clots in people with an abnormally fast heartbeat (called atrial fibrillation) or in people who get blood clots in their legs or lungs ("VTE" or venous thromboembolism). A NOAC called rivaroxaban can be used to prevent blood clots in people with heart disease. Talk to your healthcare provider to see if rivaroxaban is right for you.

Even if you are being treated with other medicines to lower your cholesterol and blood pressure, as well as antiplatelet agents, you may need some extra help from a NOAC to prevent a heart attack.

Anticoagulant to Treat Heart Disease
Rivaroxaban (Xarelto®)

People on blood thinners can have serious side effects. Call your healthcare provider if you have any of these problems:

• Unusual bruising

• Bleeding for a long time from cuts, the gums, shaving

• Nosebleeds that are uncommon or that don't stop

• Unusual pain/swelling/discomfort

• Coughing up blood

• Blood in vomit or urine

• Severe headache, dizziness/fainting, feeling tired

• Trouble swallowing

Call 9-1-1 immediately if you have any of these symptoms:

• Chest pain or pressure that comes back after rest

• Pressure, tightness, pain, or squeezing in your chest or arms that can move to your neck, jaw, or back

• Shortness of breath

• Stomach pain or nausea

• Other symptoms: cold sweat, dizziness, feeling tired

Women may not have the same symptoms as men. Some women experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness, fainting, upper back pressure, or feeling very tired. If in doubt, call 9-1-1!

Controlling your risk factors is an important part of lowering your chances of having a heart attack. Along with taking your medicines, practice these healthy habits:

• Quit smoking

• Lose weight if you are overweight

• Choose a healthy eating pattern

• Be physically active for at least 20 minutes, 3 to 4 times a week

• Limit alcohol

• Manage stress

• Get 7 to 9 hours of sleep nightly

Ask your healthcare provider these questions to find out how you can lower your risk for a heart attack and if a NOAC may be appropriate for you:

• What are my risk factors for a heart attack?

• Should I be taking a NOAC?

• What do you recommend I do to keep my heart healthy?

• When should I get emergency help?

Congratulations!

You have successfully completed the program: Lowering Your Risk for a Heart Attack: Are Blood Thinners Right for You?

View your Certificate of Completion.