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Q and A: Dangers Of Prescription Blood Thinners: And Safer Alternatives

Q:

Dear Dr. Foster,
My best friend's mother has broken out in scabs all over her body. She's taking blood thinners because of heart disease. Could this be a possible medication reaction? Also, are there any herbs that interact with blood thinners?

Signed,
Worried

A:

Dear Worried, 
You have good reason to be worried, considering the quite severe side effects of this particularly dangerous medication. In my opinion, warfarin is one of the worst drugs to hit the market. People tae this medication because their doctor prescribes it, usually after a heart attack or a blood clot. They take this medication because they do not know what else to do or any safer alternatives. (Click here to see the alternatives.) Doctors are very familiar with warfarin's long list of adverse reactions and interactions with other medications.  Most of them do not know about or understand any alternatives, either. The most troubling aspect about this medication is that it does not combine well with herbs or even simple foods, either. This medication doesn't seem to combine well with ANYTHING. There are a number of things that your friend's mother could have consumed that may have reacted with this medication and caused either a bleeding episode or a clotting episode.

Warfarin has what medical doctors call a "narrow therapeutic window." What this means in plain English is that if the dose is the slightest bit too high or the slightest bit too low, then the drug does not work. Only within a narrow dosage range does the medication work in the body. Because of this, doctors must monitor the blood levels of this medication on a regular basis to make sure that it is neither too high or too low. If the levels are too high, then the patient could have a serious bleeding episode that could lead to death. If the levels are too low, then the patient could have a clotting episode that leads to a stroke, heart attack, or the loss of fingers, toes or other extremities.

(Taken from the Physicians Desk Reference 2002.)

Warfarin is contraindicated during pregnancy:
The drug passes through the placenta between mother and fetus and can cause death to the fetus by hemorrhage. Furthermore, the drug has caused severe birth defects when used during pregnancy. These defects include brain malformations, mental retardation, blindness, and deformed eyes. Other rare abnormalities include spina bifida, cranial nerve palsy, hydrocephalus, cardiac defects, congenital heart disease, polydactyly [too many fingers or toes], deformities of toes, cleft palate, cleft lip, microcephaly and many birth defects.

Warfarin interacts with MANY medications: (Get ready - this is long)
This wide range of medications include simple medications such as antibiotics, sedatives, antidepressants, cancer chemo drugs, drugs for high cholesterol, antifungal medications, medications for ulcers and hiatal hernia, heart medications, antihistamines, estrogen-containing oral contraceptives, thyroid medications. Many of these medications are commonly used.  Alcohol, aminoglutethimide, amobarbital, atorvastatin, azathioprine, butabarbital, butalbital, carbamazepine, chloral hydrate, chlordiazepoxide, chlorthalidone, cholestyramine, clozapine, corticotropin, cortisone, cyclophosphamide, dicloxacillin, ethchlorvynol, glutethimide, griseofulvin, haloperidol, meprobamate, 6-mercaptopurine, methimazole, moricizine hydrochloride, nafcillin, paraldehyde, pentobarbital, phenobarbital, phenytoin, prednisone, primidone, propylthiouracil, raloxifene, ranitidine, rifampin, secobarbital, spironolactone, sucralfate, and trazodone. 

(Physician's Desk Reference, 56th edition, p. 1245)
See additional references

Warfarin interacts with many herbs:
including garlic, red clover, ginkgo biloba, ginger. Other herbs that warfarin could react with: alfalfa, agrimony, aloe gel, angelica (dong quai), aniseed, arnica, asa foetida, aspen, black cohosh, black haw, bladder wrack, bogbean, boldo, capsicum, cassia, celery, chamomile (German and Roman), clove, dandelion, fenugreek, feverfew, German sarsaparilla, ginseng (Panax), goldenseal, horse chestnut, horseradish, licorice, meadowsweet, mistletoe, nettle, onion, parsley, passion flower, pau d'arco, policosanol, poplar, prickly ash (Northern), quassia, red clover, senega, sweet clover, sweet woodruff,  tamarind, tonka beans, wild carrot, wild lettuce, willow, wintergreen, and yarrow. 

(Physician's Desk Reference, 56th edition, p. 1246)
See additional references

Warfarin even interacts with many foods, beverages, and vitamins:
including high dose vitamin C, alcoholic beverages, bromelain, onion, garlic, ginger, inositol nicotinate (a B vitamin), vitamin K, and foods high in vitamin K.  Pharmacists have reported bleeding episodes in patients that resulted from something as simple as eating too much broccoli soup.

(Physician's Desk Reference, 56th edition, p. 1246)
See additional references

Other blood thinners available also have severe side effects:
Other prescription blood thinning medications available include Heparin which have many side effects: 1 out of 4 people taking Heparin develop a low platelet count (thrombocytopenia) which causes bleeding: nosebleeds, etc.  This is called "Heparin-induced thrombocytopenia."

See References related to Heparin-induced thrombocytopenia

Aspirin:

Even aspirin can have severe side effects:
This includes the so-called "just a baby aspirin," enteric coated aspirin, special buffered aspirin and all other forms of aspirin. The chemical name for aspirin is acetylsalicylic acid, also abbreviated as ASA. It is completely synthetic, being produced in chemical laboratories. One aspirin  permanently damages platelets (the component of the blood responsible for clotting). It takes three days for the body to make more platelets. For this reason, the effects of aspirin last for three days. If aspirin is not buffered, the most common side effect is stomach irritation and bleeding ulcers. Bleeding ulcers may result in substantial blood loss requiring blood transfusion. (I know because this happened to my grandmother. She was taking enteric-coated baby aspirin every day for "heart health" and she ended up with a bleeding ulcer. One day, she vomited up an enormous amount of blood and had to be rushed to the hospital for a blood transfusion - and she felt fine until the day it happened, when everything went haywire) 

For those unfortunate individuals who take aspirin - buffered or otherwise - on a daily basis over the long term, permanent kidney damage 51, 55, 81, 82 is the frequent result (renal papillary necrosis 52, 53, 54, interstitial nephritis 80, analgesic nephropathy 79, protein in the urine and permanent kidney failure). It has also been named as a cause of hepatitis. 89 Thousands of years of Chinese medicine tell us that kidney malfunction is associated with hearing loss. Well, then, it should be no surprise when something that is known to cause kidney damage also causes hearing loss. Aspirin can interact with the common antibiotic Gentamicin to cause hearing loss 70. It is associated with sensorineural hearing as well as other types of hearing loss 71, 72, 73, 74, 75, 76, 77, 78.

In those who have allergic tendencies, aspirin can cause or worsen asthma attacks 69, cause severe urticaria (hives) 62, 64, 65, anaphylactic shock 61, 66, 67, 69, and angioedema (severe life-threatening allergic reaction) 64.

Even low doses can inhibit platelet function leading to an increase in bleeding time, and this can adversely affect patients with bleeding disorders. In others, it may lead to bleeding episodes such as nosebleeds, bleeding into the brain 40, 41, 42, 43, blood in the urine 47, 50, gastrointestinal bleeding 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, etc.  If taken right before childbirth, severe hemorrhaging can result. Aspirin use has also been associated with retinal bleeding 85, 86, 87, and macular degeneration. 84. Its use is known to increase the risk of hemorrhagic stroke/bleeding in the brain. 90, 91, 92

Most people are familiar with the fact that children with the flu should not take aspirin since it can cause the deadly Reye's Syndrome. It has also been reported to cause pancreatitis, hepatitis and other gastrointestinal diseases. 

An overdose of aspirin first causes ringing in the ears, then electrolyte imbalances followed by hyperthermia (fever) and acid-base disturbances of the blood which can be life-threatening. How people consider aspirin a harmless drug is beyond me.

Aspirin interacts negatively with the following medications: ACE Inhibitors, Acetazolamide, Heparin, Warfarin, Anticonvulsants (antiseizure medication), Beta blockers, Diuretics, Methotrexate, Nonsteroidal Anti-inflammatory drugs (NSAID's), Oral Hypoglycemics (diabetes medication), and Uricosuric agents (medications that treat gout).

Above information on side effects of and drug interactions with aspirin taken directly from Physician's Desk Reference, 56th Edition, p. 1715-1717)
Additional References on aspirin

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Because safer alternatives are available, the existence of serious and life-threatening side effects of blood thinning medications and the many interactions with other medications as well as with herbs, vitamins and foods is one of the reasons why I rarely ever agree with the use of prescription blood thinning medications.

Some of the MANY alternatives: 

1. Garlic: (allium sativa) Garlic is one of the most researched herbs in America.  it has been found repeatedly to have a natural blood thinning effect that is safe and well-tolerated. It is available dried, encapsulated, as an oil, and as a tincture.  Its activities are more potent when the garlic is raw. Three cloves of raw garlic per day can have a substantial effect on the functioning of the blood, and will work just as well as conventional blood thinning medications without the side effects. 

2.  Aged Garlic extract:  Kyolic has on file numerous research studies proving the effectiveness of aged garlic extract in lowering blood cholesterol levels, blood sugar levels, triglyceride levels, naturally thinning the blood and increasing the functioning of the immune system.

3.  Onion: (allium cepa) is closely related to garlic.  It has similar effects on the blood as garlic but a bit milder. It is available fresh, powdered and in Cayenne tincture form. 

4: Ginger: (zingiber officinale)  Ginger has been shown in research studies to inhibit platelet aggregation, reducing abnormal clotting of the blood and even lower elevated cholesterol and triglycerides Ginger in liquid tincture form.

5.  Cayenne: Cayenne is a time-honored tradition for healing the blood, blood vessels, circulation and heart.  It can do more to repair the heart and circulation than any medication. This is because the body uses the phytonutrients in cayenne like it uses food. Only nutrients can repair living tissue since they are incorporated into living cells as food. Chemicals cannot be incorporated into living tissue, nor would we want them to be since they are toxic. Cayenne is a great food to incorporate into the daily food plan, since, next to rosehips, it is the highest food source of vitamin C. Vitamin C is an essential vitamin used by the body to produce collagen. This collagen eventually becomes part of blood vessel walls. Without healthy collagen, blood vessels harden and become diseased.  This is atherosclerosis and arteriosclerosis.  This frequently results from defective vitamin C - deficient colllagen being incorporated into the blood vessels. Chickens fed a diet too low in copper develop atherosclerosis because copper is also requred in order to produce collagen, and without it, the blood vessels weaken and become diseased. Isolated copper supplements should not be taken since it is easy to take too high of a dose and become toxic, but the Essential Nutrients Formula accomplishes the same effect safely and naturally.

Cayenne is available in a powder or in the convenient liquid tincture form. I prefer the liquid over the powder since the powder may accidentally be inhaled and produce uncomfortable coughing or nasal burning. I also prefer the liquid over the encapsulated powdered cayenne because it is more easily accepted into the stomach. When capsules of powdered cayenne break open in the stomach, there can be lots of uncomfortable heartburn since the cayenne was not first tasted in the mouth. When the cayenne goes in first through the mouth, it stimulates digestive enzymes and allows the stomach time to get prepared for the cayenne. When taking cayenne as a daily tonic herb, make sure you start with small amounts at first and only increase the amount as tolerated. Cayenne is not suggested for those who have problems with colitis or other types of chronic diarrhea since it stimluates bowel movements. This can be a blessing for those who are constipated.

6.  The Cider Blaster Formula contains garlic, onion, ginger and cayenne and has been shown clinically to have natural blood-thinning effects. The garlic in this formula has been aged, and is therefore easier on the stomach than raw garlic. The effects of this product alone are usually enough to thin the blood substantially.  In fact, it works so well, it should not be used in combination with blood thinning medications or else the effect will be too strong.

7.  The Healthy Heart Formula: consists of herbs specifically for healing the heart and blood vessels. Red clover has a blood thinning effect that is safe and natural, and no bleeding episodes have been reported with this herb. This formula also combines the blood thinning effects of cayenne with hawthorne berry for maximum benefits to the heart.  It is particularly suitable for those who have just had a heart attack (in place of synthetic blood thinning medication) or for those wishing to avoid heart attacks in the future.

8.  Liver Regeneration Program followed by Healthy Cholesterol Formula: this is a particularly good formula for those who have high cholesterol.  Cholesterol is a fat that in excess causes the blood to thicken and to have a tendency to clot too much. The cause of this high cholesterol lies in the poor functioning of the liver. (This sluggish liver function does NOT show up on liver function tests taken by medical doctors)  If you have high cholesterol, this means that your liver is not able to process the fats and cholesterol that you are eating. This is usually a combination of eating too much cholesterol and having a sluggish liver that cannot process the overload. Doing the Liver Regeneration Program helps begin the process of clearing the excess cholesterol out of the liver and bloodstream so that the blood naturally thins out to a normal level. The Healthy Cholesterol Formula may be needed for a while afterwards to continue strengthening and cleansing the liver.

9.  The essential oil of helichrysum, ginger, marjoram or ylang ylang:  Use only one drop of this oil at a time rubbed onto the bottoms of the feet or directly over the heart area. 

10.  Natural enzyme therapy: Bromelain is the crude extract from pineapple that is a natural enzyme. In Germany, it is revered for its many healing effects including its antiedematous (reduces swelling), antiinflammatory, antithrombotic (stops abnormal blood clotting) and fibrinolytic activities (dissolves scar tissue and blood clots). High doses of enzymes are used in many natural healing protocols as a mainstay of alternative and complementary cancer therapies as well as for chronic pain. The Youthful Circulation Formula contains bromelain as well as papain and nattokinase. Nattokinase has been heavily researched as a supplement in Asia. They find there that it acts as a natural clot-buster. I find that the Youthful Circulation has probably the most powerful blood thinning effect.

11.  Switch to a plant-based diet: For high cholesterol, medical doctors usually recommend what's called the Step One Diet. This is a diet that is a bit lower in cholesterol than the standard American diet. If this diet fails to lower cholesterol, then the next recommendation is the Step Two Diet. This still includes meat, but is a bit lower in cholesterol. If this fails, then the patient is put on cholesterol-lowering medications. I don't bother talking about the Step One and Step Two Diets because I have NEVER seen or heard of them actually working. The usual scenario is that the person is put on cholesterol-lowering medications. This pushes the cholesterol number down a bit lower in about 50% of cases. 

However, cholesterol-lowering medications may not protect against heart attack or stroke. People continue to have heart attacks and strokes despite a normal cholesterol level. Yet, what we DO know is that heart attacks, strokes and high cholesterol are exceedingly rare among vegans - those who do not consume meat, fowl, fish, dairy products or eggs. Medical doctors do not suggest this diet since they are not taught to. Yet Dean Ornish's Program for reversing heart disease uses a diet very similar to this with outstanding results. His program results in lower blood pressure readings, lower cholesterol readings and reversal of coronary artery disease so that coronary bypass surgery is no longer needed.

12.  Use a Green formula containing algae. A green formula contains greens such as spirulina, chlorella, alfalfa, wheat grass, barley grass, kamut, oat grass, Dunaliella, etc. There are many green formulas available in your local health food store. The formula I use is called Essential Nutrients. In addition to supplying vitamin C and bioflavonoids necessary for building healthy blood vessels,  it also supplies many essential trace minerals such as copper and essential amino acids. Unhealthy blood vessel walls are prone to developing atherosclerosis with its devastating consequences including heart attack, stroke and blood clots.

13. Chinese medicine: many Chinese herbs help increase circulation and clean out fatty debris from the blood vessels. Check with your Chinese practitioner to see which of these herbs will work best for your particular body type and situation.  If you choose Chinese herbs for thinning the blood, don't also take Western herbs to thin the blood.

14: Caution: do not discontinue any heart medications without the approval of your doctor.  Many if not most heart medications must be tapered off gradually. If stopped suddenly, they may cause severe withdrawal symptoms. It is imperative that you work with your doctor when taking heart medications. I highly discourage the use of conventional blood-thinning medications, but if taking them, it is possible to get off of them. To do this requires a slow gradual addition of blood thinning remedies and a gradual tapering of the medication. Even something as simple as a dietary change can result in bleeding episodes in those who are taking these synthetic medications. This is not an easy process, and it requires the cooperation of a medical doctor who is open to it, therefore, it is highly recommended to never get on these synthetic blood-thinning medications to start with.

15.  Only one remedy should be tried at a time. If the desired effect is not achieved, then other remedies can be added until the desired blood thinning effects are achieved. An exception is the Essential Nutrients or Earth's Nutrition Formula which can be combined with any remedy.  I do not recommend fish oil because it comes from fish livers. Researchers have repeatedly tested fish livers and found them to be toxic with mercury, arsenic and polychlorobiphenyls (PCB's). The FDA advises pregnant to avoid eating fish due to all of the contaminants, therefore why would fish oil be any different? Fish oil does not clean deposits from the walls of the arteries, it simply thins the blood, and some studies show that it thins the blood too much which can cause small strokes with microhemorrhages into the brain. We need to remember that the blood is thick because of accumulated fats, cholesterol and other toxins in the bloodstream. Herbal cleansing programs as well as dietary changes remove these deposits, but fish oil does not do this.

If at first you don't succeed with the abovementioned suggestions, then keep trying until you do. Don't give up if one remedy doesn't do the job - just keep adding on additional remedies. It also may take two to six months for the arteries to clear themselves out completely of the cholesterol deposits and the blood to thin, so this process requires a a bit of patience. However, the results are long-lasting and well worth it. These results cannot be achieved by those who are following conventional medical advice only. For those who adopt a primarily vegan diet, the results are usually apparent after one month and sometimes two months. Every once in a while I run into a strict vegetarian who has high cholesterol. This is quite rare.  In these cases, the problem was due to liver toxicity. This is a problem that can be reversed with the Liver Regeneration Program.

Herbs For the Blood

P.S. This article has been revised several times since I first wrote it several years ago, mainly due to uneducated people making negative comments and not realizing that I am a conventionally trained medical doctor with a wide repertoire of medical knowledge. At that time, no one was questioning prescription medications or the harm that they can cause. People were not challenging their medical doctors on side effects of medications. I quote what is in major medical reference books and research studies because it's difficult for many people to believe that the medical profession is knowingly manufacturing medicines that their own research shows is harmful. The scientific community freely admits its own shortcomings with these types of drugs and the truth hurts. They cannot deny it - it's their own research that proves it. To dispel any and all doubt, I've listed 92 conventional research studies below on aspirin and blood thinners. These are major medical studies conducted by major universities, medical clinics, hospitals, health organizations and top research scientists around the world. All of them are real research studies that can be found online. I know it's difficult to believe the medical profession produces drugs that damage people. But examine the evidence for yourself - it's there. Thank you very much for your understanding.  

Very sincerely yours in health,
Dr. Foster  

About the author:

Dr. Cynthia Foster, M.D.

A Conventionally Trained Medical Doctor Who Left Medicine Almost 20 Years Ago to Practice 100% Holistically

After receiving a required Hepatitis B vaccine for entry into medical school, Dr. Cynthia Foster became severely ill with grand mal epileptic seizures. The seizures occurred twice daily for almost four years – almost the entire time she was in training to become a conventional medical doctor at the University of Texas Health Science Center. Putting her life into the hands of a very experienced holistic nurse who was using holistic healing methods with unprecedented and extraordinary results, she refused all medications or other medical interventions for the seizures.

Using only natural methods as her treatment, the seizures went into complete remission, and she has been seizure-free for over 20 years. Her first book Stop the Medicine tells the incredible story of her miraculous recovery as well as giving a behind-the-scenes look at the Modern Medical Establishment. In her search for healing, she has traveled the world learning and incorporating natural methods into her holistic practice, including herbal detox, natural supplements, aromatherapy, hydrotherapy, energy healing, mind-body medicine, healing visualizations, juice fasting and therapeutic foods.

After receiving her MD degree, and refusing to practice medicine because of the miraculous healings she had seen in others and experienced for herself, she began her practice using only natural methods to heal her patients, specializing in teaching people how to heal themselves with simple remedies and techniques, and has been able to repeat the miraculous healing results with her patients that she herself had personally experienced.

Over the past 20 plus years, she has served many roles including not only healing practitioner, but also herbal product trainer and spokesperson for herbal product companies, and also founded her own pharmaceutical strength herbal product line called “Dr. Foster’s Essentials” to address the health problems she was seeing in her practice. She noticed over a period of two decades of seeing patients, that they usually brought her grocery bags full of so-called “natural” supplements that simply did not work. She founded Dr. Foster’s Essentials, insisting on including herbal extracts up to ten times stronger than what is traditionally available in grocery stores, drug stores health food stores, and even online, as she felt these “mass-marketed” remedies were too weak and watered down to heal anything as serious as what she had experienced with the epilepsy.

A highly sought after speaker and university instructor, she has lectured worldwide on a wide range of topics from the use of herbs to emotional healing to conventional medicine classes for acupuncture students. She has been interviewed numerous times on radio programs and mentioned in the press as well as featured in magazines, newspapers, and on television. Current projects include a second book describing how to use herbs and natural healing techniques to overcome life-threatening, chronic and incurable health issues.



Additional Scientific References:

1: Am J Med. 2007 Aug;120(8):700-5. Epub 2007 May 24. Fang MC, Go AS, Chang Y, Hylek EM, Henault LE, Jensvold NG, Singer DE. Death and disability from warfarin-associated intracranial and extracranial hemorrhages.

2: Harv Heart Lett. 2007 Jul;17(11):7. Goldhaber SZ. Ask the doctor. Is warfarin turning my toes purple?

3: CMAJ. 2007 Aug 14;177(4):347-51. Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding.

4: South Med J. 2007 Jul;100(7):720-4. Vadlamudi RS, Smalligan RD, Ismail HM. Interaction between warfarin and levofloxacin: case series.

5: Arch Intern Med. 2007 Jul 9;167(13):1414-9. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action.

6: J Neuroimaging. 2007 Jul;17(3):246-50. Romero JR, Sakai O, Rice MB, Babikian VL. Intracranial hemorrhage sparing meningioma in an anticoagulated patient.

7: Cornea. 2007 Jul;26(6):742-3. Hasan SA. Interaction of doxycycline and warfarin: an enhanced anticoagulant effect.

8: Ann Pharmacother. 2007 Jul;41(7):1292-5. Epub 2007 Jun 12. Westergren T, Johansson P, Molden E. Probable warfarin-simvastatin interaction.

9: Circulation. 2007 May 29;115(21):2689-96. Epub 2007 May 21. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation.

10: Am J Geriatr Cardiol. 2005 Mar-Apr;14(2):98-9. DeSilvey DL. Clinical trials: advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation.

11: Scand J Prim Health Care. 2007 Jun;25(2):123-8. Wallvik J, Sjalander A, Johansson L, Bjuhr O, Jansson JH. Bleeding complications during warfarin treatment in primary healthcare centres compared with anticoagulation clinics.

12: Ir Med J. 2007 Sep;100(8):569-71. Iqbal R, Mulvihill NT, Nolan B, Crean PA. Multivessel coronary thrombosis resulting from heparin induced thrombocytopenia.

13: Ann Thorac Cardiovasc Surg. 2007 Oct;13(5):365-7. Masumoto H, Shimamoto M, Yamazaki F, Nakai M, Fujita S, Itonaga T, Nomura R. A Case of Heparin-Induced Thrombocytopenia with Repeated Episodes of Acute Lower Extremity Arterial Thromboembolism during a Short Time.

14: Ann Thorac Surg. 2007 Nov;84(5):1548-53; discussion 1554-5. Kerendi F, Thourani VH, Puskas JD, Kilgo PD, Osgood M, Guyton RA, Lattouf OM. Impact of heparin-induced thrombocytopenia on postoperative outcomes after cardiac surgery.

15: Cardiovasc Hematol Disord Drug Targets. 2007 Sep;7(3):153-62. Review. Castelli R, Cassinerio E, Cappellini MD, Porro F, Graziadei G, Fabris F. Heparin induced thrombocytopenia: pathogenetic, clinical, diagnostic and therapeutic aspects.

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17: Postgrad Med J. 2007 Sep;83(983):575-82.Ahmed I, Majeed A, Powell R. Heparin induced thrombocytopenia: diagnosis and management update.

18: Am J Hematol. 2007 Dec;82(12):1116-7. Prasad HK, Govindarajan R. Heparin-induced skin necrosis associated with thrombocytopenia and acquired protein C and protein S deficiency.

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21: Am J Ther. 2007 Jul-Aug;14(4):408-10. Singh S, Verma M, Bahekar A, Agrawal P, Duggal J, Iliescu M, Khosla P, Muzaffar S. Enoxaparin-induced skin necrosis: a fatal outcome.

22: J Infus Nurs. 2007 Jul-Aug;30(4):232-40. Review. Swanson JM. Heparin-induced thrombocytopenia: a general review.

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24: Eur J Haematol. 2007 Sep;79(3):187-90. Epub 2007 Jul 26. Lubenow N, Hinz P, Ekkernkamp A, Greinacher A. Should patients be informed about the risk of heparin-induced thrombocytopenia before prolonged low-molecular-weight heparin thromboprophylaxis post-trauma/orthopedic surgery?

25: Am J Orthop. 2007 May;36(5):255-60. Review. Patel VP, Bong M, Di Cesare PE. Heparin-induced thrombocytopenia and thrombosis.

26: Angiology. 2007 Apr-May;58(2):234-7. Dickinson BP, Lawrence PF. Bilateral lower extremity gangrene requiring amputation associated with heparin-induced thrombocytopenia: a case report.

27: Blood Coagul Fibrinolysis. 2007 Jun;18(4):317-20. Davidson SJ, Wadham P, Rogers L, Burman JF. Endothelial cell damage in heparin-induced thrombocytopenia.

28: J Med Case Reports. 2007 Apr 30;1:13. Cormack GM, Kaufman LJ. Severe heparin-induced thrombocytopenia: when the obvious is not obvious, a case report.

29: J Thromb Haemost. 2007 Jul;5(7):1371-2. Epub 2007 Apr 16. Arnold DM, Kelton JG. Testing for heparin-induced thrombocytopenia: are we there yet?

30: Expert Opin Drug Saf. 2006 Jul;5(4):585-92. Review. Leong RW, Chan FK. Drug-induced side effects affecting the gastrointestinal tract.

31: Presse Med. 2003 Nov 22;32(37 Pt 2):S17-28. Review. French. Sibilia J, Ravaud P, Marck G. [Digestive and hemorrhage complications of low-dose aspirin]

32: Lancet. 1999 Feb 20;353(9153):676. Meade TW. Aspirin, myocardial infarction, and gastrointestinal bleeding.

33: Int J Clin Pharmacol Ther. 1994 Dec;32(12):675-82. Huic M, Mucolic V, Vrhovac B, Francetic I, Bakran I, Giljanovic S. Adverse drug reactions resulting in hospital admission.

34: Arzneimittelforschung. 1994 Jul;44(7):840-3. Muller P, Simon B. Effects of ibuprofen lysinate and acetylsalicylic acid on gastric and duodenal mucosa. Randomized single-blind placebo-controlled endoscopic study in healthy volunteers.

35: Aliment Pharmacol Ther. 1993 Oct;7(5):515-21. Hudson N, Murray FE, Cole AT, Turnbull GM, Lettis S, Hawkey CJ. Ranitidine bismuth citrate and aspirin-induced gastric mucosal injury.

36: Scand J Gastroenterol. 1993 Sep;28(9):767-71. Konturek JW, Dembinski A, Stoll R, Konturek M, Domschke W. Gastric mucosal blood flow and neutrophil activation in aspirin-induced gastric mucosal damage in man.

37: Am J Gastroenterol. 1991 Jun;86(6):735-7. Lanza FL, Evans DG, Graham DY. Effect of Helicobacter pylori infection on the severity of gastroduodenal mucosal injury after the acute administration of naproxen or aspirin to normal volunteers.

38: Gastroenterol Clin Biol. 1989 Dec;13(12):1094. Sarfati E, Roland E, Gossot D, Celerier M. [Bleeding of Meckel's diverticulum after ingestion of aspirin]

39: J Clin Pharmacol. 1989 Jun;29(6):559-62.Friedman H, Seckman CE, Schwartz JH, Lanza FL, Royer GL, Stubbs CM. The effects of flurbiprofen, aspirin, cimetidine, and antacids on the gastric and duodenal mucosa of normal volunteers. An endoscopic and photographic study.

40: Stroke. 2006 Jan;37(1):129-33. Epub 2005 Dec 1. Saloheimo P, Ahonen M, Juvela S, Pyhtinen J, Savolainen ER, Hillbom M. Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death.

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