The FDA issued a revision to the boxed warning for enoxaparin in October 2013.  The revision recommends exercising caution regarding when spinal catheters are placed and removed in persons taking enoxaparin for spinal puncture or neuroaxial anesthesia .  It may be necessary to delay anticoagulant dosing in these persons in order to decrease the risk for spinal or epidural hematomas, which can manifest as permanent or long-term paralysis .  Persons at risk for hematomas may present with indwelling epidural catheters, concurrent use of medications that worsen bleeding states such as non-steroidal anti-inflammatory drugs (NSAIDs) , or a past medical history of epidural or spinal punctures, spinal injury, or spinal deformations.  The FDA recommends that at-risk persons be monitored for bleeding and neurological changes.  
A team of scientists led by Dr. Brian F. Gage at Washington University in St. Louis investigated whether genetic testing can help predict the best warfarin dose to give a patient. They compared outcomes for patients whose initial doses were based on clinical information alone to those whose initial doses were based on their genetic makeup (genotype) along with clinical factors. The trial was funded primarily by NIH’s National Heart, Lung, and Blood Institute (NHLBI). Results appeared in the Journal of the American Medical Association on September 26, 2017.
It is very important that when blood thinner medications are prescribed that they are taken as directed. Although there is some concern about blood thinners side effects , especially with mainstays like Warfarin, they are used in persons where the benefits outweigh the potential risks associated with using them. Some may consider natural blood thinners in alternatively to prescription medications, however while there are some natural choices like foods and herbs that are able to thin blood effectively, they are no substitute for medical treatment and care. It is absolutely essential to receive medical attention for blood clots and to follow the advice of a health care provider as well as reduce lifestyle factors that may contribute to an increased risk of clots. This includes quitting smoking and losing weight, some common answers to the question of what causes blood clots. With medical care, counseling and advice and lifestyle changes, as well as one of many different types of blood thinner medications, the risk of clots can be reduced substantially, and we’ve compiled a list of the top ten medications used for this purpose to provide more information on how they help to stave off the formation of abnormal clots.