Is Lipitor (atorvastatin) a blood thinner?

Lipitor is a statin drug that has some similar mechanisms to blood thinners. Compare stains and blood thinners.

By Chad Shaffer, MD | Sep. 9, 2022

Is atorvastatin a blood thinner? | Are statins blood thinners? | Statins vs. blood thinners | Can you take statins with blood thinners?

Treatment of heart disease often requires both cholesterol-lowering and blood-thinning medications. Naturally, when you look over your list of prescriptions, you may wonder what each drug is doing to help you. Lipitor (atorvastatin) is on the list for many people who have heart problems or are attempting to prevent those issues. It falls under the category of cholesterol medications called statins. Atorvastatin is not a blood thinner but read on to learn how it does have some similar actions. You will also discover the critical differences between blood thinners and cholesterol drugs, two vital drug types for reducing your risk of heart problems.

Is atorvastatin a blood thinner?

Lipitor (atorvastatin) is a statin, reducing blood cholesterol by inhibiting the HMG CoA reductase enzyme. The primary action of HMG CoA reductase inhibitors is to reduce low density lipoprotein (LDL), which is termed bad cholesterol as opposed to high density lipoprotein (HDL or good cholesterol). Lowering LDL likely has a lot to do with the ability of statins like Lipitor and Crestor (rosuvastatin) to reduce atherosclerosis or cholesterol plaque build up in blood vessels. Of course, a comprehensive approach to atherosclerosis treatment would also include addressing high blood pressure, controlling sugar levels in Type 1 or Type 2 diabetes mellitus, and quitting smoking.

The mechanisms by which atorvastatin helps reduce the risk of heart attack are multifold and extend far beyond simply lowering cholesterol. For one, atorvastatin can reduce inflammation. This may explain why statins are immediately helpful when instituted during a heart attack. Secondly, Lipitor can affect mediators of blood vessel constriction, providing a plausible mechanism by which it could help to dilate arteries to improve circulation. Finally, it is worth knowing that atorvastatin can reduce the activity of platelets, our blood cells responsible for producing blood clots. A reduction in clot formation could translate to a reduction in heart attack risk. As you can see, the effectiveness of statin drugs like Lipitor relies on a complex array of mechanisms.

Nonetheless, it is important to recognize that despite its various actions, atorvastatin should not be considered an anticoagulant or blood thinner. The term “blood thinner” implies an extensive reduction in clotting, as well as an increase in bleeding risk as a consequence. Although Lipitor can impact platelet action, this effect should not lead to labeling the drug a blood thinner. Doing so could lead to misunderstanding and mismanagement. Reviewing the differences between statins and blood thinners can help you to understand why.

Are statins blood thinners?

Statin therapy in general, not just atorvastatin, has proven helpful in treating heart disease, by lowering lipid levels, reducing inflammation, dilating arteries, and inhibiting platelets. Each member of the category has not been evaluated for each of these mechanisms, but multiple members, including Pravachol (pravastatin) and Mevacor (lovastatin), have been found to have some of these additional actions besides cholesterol reduction. Any statin’s ability to impact blood clotting does not meet the standard level of clotting abilities compared to blood thinners. Likewise, Xarelto (rivaroxaban) is a common blood thinner, and while it has been associated with lower cholesterol levels in a study in rats, rivaroxaban is not considered a cholesterol lowering medication. Blood thinners and statins are two very distinct drug classes regardless of any overlapping effects.

For example, the Food and Drug Administration (FDA) indications for statins primarily includes cholesterol reduction and cardiovascular disease and for blood thinners primarily includes treatment and prevention of blood clot conditions. Furthermore, the side effects are quite different. Monitoring of blood tests for liver damage or muscle enzyme elevation may be required for statins, but gauging blood cell counts, and clotting assays may be necessary for blood thinners. Contraindications, or reasons to strictly avoid a medication, vary between the drug classes too. When comparing the two categories, it should be recognized that statins are a more uniform group of drugs, whereas blood thinners vary more regarding their mechanisms of action, uses, adverse effects, contraindications, and drug interactions. General comparisons between the classes can still be made.

Statins vs. blood thinners
	Statins	Blood thinners
How it works	Inhibit HMG CoA reductase to produce lower cholesterol levels	Inhibit enzymes or platelets that engage in blood clot formation
Indications / uses	High cholesterol conditions including high LDL or triglyceride levels, cardiovascular event risk reduction, atherosclerotic cardiovascular disease	Deep venous thrombosis and pulmonary embolism (blood clot conditions) treatment and prevention, prevention of stroke in the setting of atrial fibrillation or certain heart valves
Side effects	Muscle pain, joint pain, liver problems, cognitive impairment, rhabdomyolysis (muscle tissue breakdown)	Bleeding, abdominal pain, blood cell count disturbance, hepatitis, skin problems
Interactions	Cyclosporine, fibrates like gemfibrozil, macrolide antibiotics like clarithromycin, antivirals like ritonavir, antifungals like fluconazole, opiates like oxycodone, grapefruit juice	Variable drug interactions within the category but commonly macrolide antibiotics like clarithromycin, antivirals like ritonavir, antifungals like fluconazole, opiates like oxycodone
Contraindications	Liver disease, myopathy, most pregnancies, history of hypersensitivity allergic reaction to the drug or class	Active bleeding, spinal puncture, history of hypersensitivity allergic reaction to the drug or class, some drugs are contraindicated in advanced liver disease, kidney disease, pregnancy, and breastfeeding
Examples of brand names	Lipitor, Crestor, Livalo, Zocor, Pravachol, Mevacor, Lescol XL	Eliquis, Xarelto, Pradaxa, Plavix, Brilinta, Effient, Coumadin, Lovenox

Can you take statins with blood thinners?

As you can see, there are several drug interactions to be aware of with statin drugs and blood thinners. Only a few examples are listed above. You would be wise to review your list of prescription drugs, over-the-counter medications, and supplements with your healthcare provider before starting treatment and periodically while taking blood thinners or statins. The two classes have some interactions between each other as well. Statins can increase the blood thinning effect of warfarin. Plavix (clopidogrel) and Brilinta (ticagrelor) can increase the muscle adverse effects of statins. Zocor (simvastatin) can increase the bleeding risk of Eliquis (apixaban). Despite these potential drug interactions between the classes, statins and blood thinners are generally considered safe to be taken concurrently. Get the medical advice of a healthcare professional to be sure, but the fact is that these drug classes are often used together due to the frequent combination of blood clotting and cholesterol problems in cardiovascular disease.