Taking blood thinners as part of your atrial fibrillation (AFib) treatment may lower your risk of stroke by up to 60 percent. Doctors often prescribe warfarin (Coumadin) as a long-term blood thinner. This drug can be effective, but it requires frequent monitoring and may interact with a number of drugs and foods.

What exactly happens if your blood thinner just isn’t working out? Read on to find out more about blood thinners, particularly warfarin, and some steps to discuss with your doctor if your blood thinner isn’t working.

How blood thinners work

You may feel perfectly healthy and wonder why you’d need a blood thinner for AFib. Even if you have no symptoms, blood can pool and collect in your heart, creating clots that can travel to different parts of your body. If a clot travels to your brain, the blood supply will get cut off, and you’ll have a stroke.

How do these medications work? Blood thinners block vitamin K from feeding the different clotting agents in your blood. When you prevent clots, you prevent stroke. These medications don’t block your blood’s ability from clotting completely, though.

Warfarin is the most commonly prescribed blood thinner. It can be taken long term — for the rest of your life, if necessary. To keep your blood in a target range for clotting, you’ll need frequent monitoring through a blood test called a prothrombin time test. This test measures how long it takes your blood to clot.

Your dosage may change over time depending on your results from this test. Warfarin is color-coded according to dosage, so you may see different colored pills while taking the drug.

Warfarin does interact with different medications or even with foods high in vitamin K. It may lead to bleeding and even excessive bleeding — internal or external — if not taken correctly or if you get injured. To avoid complications, it’s important to take warfarin exactly as it’s prescribed by your doctor and report any cuts or falls that may put you at risk for bleeding.

5 steps to take if your blood thinner isn’t working

A blood thinner like warfarin might not work for you for several reasons. Before you stop taking it, speak with your doctor. You may need to change aspects of your lifestyle to get things working better. As well, newer drugs are available that you might be able to try. If you want to stop taking blood thinners altogether, a couple of alternatives may keep your risk of stroke low.

1. Visit your doctor

Call your doctor if you have concerns about your blood thinner. Explain your side effects or other issues, like drug interactions, and see if they have any advice. If you do choose to go off the medication, your doctor will be able to give you the best instructions on how to do so safely.

Warfarin requires frequent monitoring to see if it’s working well. Before you go off the medication, your doctor may ask you to have a blood test to see if you need a different dosage. If that’s not the issue, you can then discuss other options to prevent clotting.

2. Examine your diet

Your blood thinner may not be working well if you eat certain foods that contain high amounts of vitamin K. These foods include leafy greens like kale, spinach, Swiss chard, and collards.

Supplements like omega-3 fatty acids may also cause issues with warfarin. If you’re eating these foods or taking supplements, changing up your routine may help.

There are many healthy foods you can eat that don’t interact with this medication. For example, sweet potatoes, carrots, and squash are good choices. Your doctor may have suggestions for a diet that will work well with your medication. You may even ask for a referral to a dietitian who can give you ideas on what foods will complement your treatment plan.

3. Discuss newer drugs

While warfarin is the most commonly prescribed blood thinner, there are newer drugs on the market. These drugs are likely an option for people with nonvalvular AFib, though your doctor is your best resource to find out if you’re a good candidate. They include:

Newer drugs are just as effective as warfarin. The difference is that they are shorter-acting. As a result, they don’t require monitoring as often. They also don’t have as many food and drug interactions, making them a safe choice for your lifestyle.

4. Ask about implants

If you’ve tried other blood thinners and still aren’t satisfied with them, there are alternatives you can discuss with your doctor. Implants like the WATCHMAN may help reduce your risk of clots without the use of medications. This device blocks off the left atrial appendage in your heart, the area where blood often pools and collects, forming clots.

The WATCHMAN is inserted into your heart through a catheter that starts in your leg. Once it’s in place, it generally takes 45 days for a layer of tissue to grow over it and block the left atrial appendage off completely.

The device is suitable for people who have nonvalvular AFib and who have a good reason for wanting to stop taking blood thinners. It isn’t recommended to people who already have a clot in their heart, are sensitive to nickel or titanium, or can’t take blood thinners. As a result, you’ll need to check with your doctor to see if this device is an option for you.

5. And about other procedures

Like the WATCHMAN implant, the LARIAT procedure prevents blood from forming clots in the left atrial appendage. Instead of implanting a device, this procedure uses sutures to tie off the appendage, which eventually turns into scar tissue.

During the procedure, your doctor will numb an area on your chest and insert two catheters through punctures in your skin. This means less pain and faster recovery time versus what you might experience with more serious surgery.

Ask your doctor if the LARIAT procedure may help you go off blood thinners and reduce your risk of stroke. You might also want to find out if implants and other alternative procedures are covered by your insurance, as they may be costly otherwise.

The takeaway: Discuss your options

Before stopping your blood thinning medication, talk to your doctor about all your options. You may still wish to discontinue using blood thinners after discussing lifestyle modifications, changes in dosage, and newer drugs. The good news is that drug-free alternatives are available. You may be able to prevent blood clots due to AFib and keep your risk of stroke low without medications. The key is keeping the line of communication open with your healthcare team.