Anticoagulants (blood thinners) reduce the blood’s ability to form clots, which is necessary for preventing serious conditions like stroke or heart attack. Receiving chiropractic care while on these medications requires careful consideration and a collaborative approach between the patient, the prescribing physician, and the chiropractor. While pain relief is still needed, blood thinners introduce specific risks that must be managed. Chiropractic treatment is possible, but it must be undertaken with caution and only after medical clearance and preparation.
Understanding the Specific Risks of Anticoagulation
The primary concern for patients on blood thinners is the increased risk of bleeding and bruising. High-velocity, low-amplitude (HVLA) chiropractic thrusts can cause minor soft tissue tears. Anticoagulation prevents the natural clotting response, potentially leading to a deep tissue hematoma (a localized collection of blood) in the muscle or around the spine. A rare but serious complication is a spinal epidural hematoma, where blood collects near the spinal cord, potentially causing neurological symptoms.
A specific, though rare, risk involves cervical (neck) manipulation. Quick, rotational movements stress the vertebral arteries, which supply blood to the brain. This stress is linked to vertebral artery dissection (VAD), where the inner lining of the artery tears. For patients on blood thinners, this risk is heightened because the compromised vessel wall heals poorly. A blood clot forming at the dissection site is more likely to travel to the brain, potentially causing an ischemic stroke.
Mandatory Medical Communication and Clearance
Full disclosure of all medications, including dosage and frequency, is mandatory before receiving chiropractic treatment. The chiropractor needs this information to conduct an accurate risk assessment before any examination or treatment begins. This process requires obtaining explicit medical clearance from the physician managing the patient’s anticoagulation therapy, usually the prescribing doctor or a cardiologist.
For patients taking Warfarin (Coumadin), recent blood testing for the International Normalized Ratio (INR) is required. The INR measures how long it takes blood to clot. For high-risk procedures, the INR is generally required to be 1.4 or less, though 2.0 or less may be acceptable for lower-risk procedures. For patients on newer oral anticoagulants (DOACs) like Apixaban or Rivaroxaban, the physician may recommend temporarily stopping the medication for two to four days prior to high-risk manipulation.
Modifying Chiropractic Treatment Techniques
The heightened bleeding risk requires a shift in the chiropractor’s treatment approach. The standard high-velocity, low-amplitude (HVLA) thrust, especially in the neck, is often avoided due to the potential for vascular strain and deep tissue injury. Treatment focuses instead on gentler, low-force techniques that provide therapeutic benefit without compromising soft tissue integrity.
Chiropractors often substitute forceful adjustments with mobilization, using slow, rhythmic movements of the joint within its normal range of motion. They may also use mechanical adjusting instruments, such as the Activator Method, that deliver a controlled, low-force impulse. Gentle soft tissue work, including massage and trigger point therapy, is incorporated to address muscle tension, but deep techniques are avoided to prevent bruising or hematoma formation.
Complementary physical modalities like heat or cold therapy may also be used to manage pain and inflammation without adding mechanical stress. The goal is to maximize functional improvement using methods that pose the lowest risk of bleeding complications.
Warning Signs Requiring Immediate Medical Attention
Following chiropractic treatment, patients on blood thinners must monitor for specific symptoms indicating a complication. New, large, or rapidly spreading bruising or swelling in the treated area is a warning sign of internal bleeding or a hematoma requiring immediate medical evaluation. Any unexplained, persistent, or worsening pain should also be reported quickly.
Patients must be vigilant for neurological signs that may signal a vascular event, such as a stroke. These symptoms are summarized by the F.A.S.T. acronym:
- Facial drooping
- Arm weakness
- Speech difficulty
- Time to call emergency services
A sudden, severe headache, often described as the “worst headache of your life,” requires immediate emergency care, as it may indicate a serious intracranial issue. Other concerning symptoms include sudden dizziness, balance problems, or double vision.