Anticoagulant and antiplatelet drugs
Anticoagulants are drugs used to prevent clot formation or to prevent a clot that has formed from enlarging. They inhibit clot formation by blocking the action of clotting factors or platelets. Anticoagulant drugs fall into one of three categories: inhibitors of clotting factor synthesis, inhibitors of thrombin, and antiplatelet drugs.
Anticoagulant drugs reduce the ability of the blood to form clots. Although blood clotting is essential to prevent serious bleeding in the case of skin cuts, clots inside the blood vessels block the flow of blood to major organs and cause heart attacks and strokes. Although these drugs are sometimes called blood thinners, they do not actually thin the blood. Furthermore, this type of medication will not dissolve clots that already have formed, although the drug stops an existing clot from worsening. However, another type of drug, used in thrombolytic therapy , will dissolve existing clots.
Anticoagulant drugs are used for a number of conditions. For example, they may be given to prevent blood clots from forming after the replacement of a heart valve or to reduce the risk of a stroke or another heart attack after a first heart attack. They are also used to reduce the chance of blood clots forming during open-heart surgery or bypass surgery. Low doses of these drugs may be given to prevent blood clots in patients who must stay in bed for a long time after certain types of surgery. They may also be used to prevent the formation of clots in needles or tubes that are inserted into veins, such as indwelling catheters.
Anticoagulants may be given after major surgery to prevent the formation of clots due to lack of physical activity. Patients who are unable to move around may be at risk of developing clots, particularly in the legs. Anticoagulants are given to prevent this. At the same time, compression stockings may be used to reduce the risk of clots in the legs. Compression stocks are worn on the lower legs, and act by increasing the pressure on the veins of the leg, then relaxing. The compression-relaxation keeps the blood in the veins moving, and reduces the risk of clots following surgery.
Because anticoagulants affect the blood's ability to clot, they can increase the risk of severe bleeding and heavy blood loss. It is thus essential to take these drugs exactly as directed and to see a physician regularly as long as they are prescribed. With some of these drugs, regular blood tests, as often as once a day, may be required.
Most anticoagulant drugs are available only with a physician's prescription. They come in tablet and injectable forms. They fall into three groups:
- Inhibitors of clotting factor synthesis. These anticoagulants inhibit the production of certain clotting factors in the liver. One example is warfarin (brand name: Coumadin).
- Inhibitors of thrombin. These drugs interfere with blood clotting by blocking the activity of thrombin. They include heparin and lepirudin (Refludan).
- Antiplatelet drugs. These drugs interact with platelets, which is a type of blood cell, to block platelets from aggregating into harmful clots. They include aspirin , ticlopidine (Ticlid), clopidogrel (Plavix), tirofiban (Aggrastat), and eptifibatide (Integrilin).
The recommended dosage depends on the type of anticoagulant drug and the medical condition for which it is prescribed. The prescribing physician or the pharmacist who fills the prescription can provide information concerning the correct dosage. Usually, the physician will adjust the dose after checking the patient's clotting time.
Anticoagulant drugs must be taken exactly as directed by the physician. Larger or more frequent doses should not be taken, and the drug should also not be taken for longer than prescribed. Taking too much of this medication can cause easy bruising or severe bleeding. Anticoagulants should also be taken on schedule. A record of each dose should be kept as it is taken. If a dose is missed, it should be taken as soon as possible followed by the regular dose schedule. However, a patient who forgets to take a missed dose until the next day should not take the missed dose at all and should not double the next dose, as this could lead to bleeding. A record of all missed doses should be kept for the prescribing physician who should be informed at the scheduled visits.
Persons who take anticoagulants should see a physician regularly while taking these drugs, particularly at the beginning of therapy. The physician will order periodic blood tests to check the blood's clotting ability. The results of these tests will help the physician determine the proper amount of medication to be taken each day.
Time is required for normal clotting ability to return after anticoagulant treatment. During this period, patients must observe the same precautions they observed while taking the drug. The length of time needed for the blood to return to normal depends on the type of anticoagulant drug that was taken. The prescribing physician will advise as to how long the precautions should be observed.
People who are taking anticoagulant drugs should tell all physicians, dentists, pharmacists, and other medical professionals who provide them with medical treatments or services that they are taking such a medication. They should also carry identification stating that they are using an anticoagulant drug.
Other prescription drugs or over-the-counter medicine—especially aspirin—should be not be taken without the prescribing physician being informed.
Because of the risk of heavy bleeding, anyone who takes an anticoagulant drug must take care to avoid injuries. Sports and other potentially hazardous activities should be avoided. Any falls, blows to the body or head, or other injuries should be reported to a physician, as internal bleeding may occur without any obvious symptoms. Special care should be taken in shaving and in brushing and flossing the teeth. Soft toothbrushes should be used and the flossing should be very gentle. Electric razors should be used instead of a blade.
Alcohol can change the way anticoagulant drugs affect the body. Anyone who takes this medicine should not have more than one to two alcoholic drinks at any one time, and should not drink alcohol every day.
People with specific medical conditions or who are taking certain other medicines can have problems if they take anticoagulant drugs. Before taking these drugs, the prescribing physician should be informed about any of these conditions.
ALLERGIES. Anyone who has had unusual reactions to anticoagulants in the past should let the physician know before taking the drugs again. The physician should also be told about any allergies to beef, pork, or other foods; dyes; preservatives; or other substances.
PREGNANCY. Anticoagulants may cause many serious problems if taken during pregnancy. Birth defects, severe bleeding in the fetus, and other problems that affect the physical or mental development of the fetus or newborn are possible. The mother may also experience severe bleeding if she takes anticoagulants during pregnancy, during delivery, or even shortly after delivery. Women should not start taking anticoagulants during pregnancy and should not become pregnant while taking the drug. Any woman who becomes pregnant or suspects that she has become pregnant while taking an anticoagulant should check with her physician immediately.
BREASTFEEDING. Some anticoagulant drugs may pass into breast milk. Blood tests can be done on nursing babies to see whether the drug is causing any problems. If it is, other medication may be prescribed to counteract the effects of the anticoagulant drug.
OTHER MEDICAL CONDITIONS. Before using anticoagulant drugs, people should inform their physician about any medical problems they have. They should also let the physician who prescribed the medicine know if they are being treated by any other medical physician or dentist. In addition, people who will be taking anticoagulant drugs should let their physician know if they have recently had any of the following:
- fever lasting more than one to two days
- severe or continuing diarrhea
- heavy or unusual menstrual bleeding
- insertion of an intrauterine contraceptive device (i.e., IUD)
- falls, injuries, or blows to the body or head
- any type of surgery, including dental surgery
- spinal anesthesia
- radiation treatment
- any intestinal condition
The most common minor side effects are bloating or gas. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
More serious side effects may occur, especially if excessive anticoagulant is taken. If any of the following side effects occur, a physician should be notified immediately:
- bleeding gums
- sores or white spots in the mouth or throat
- unusual bruises or purplish areas on the skin
- unexplained nosebleeds
- unusually heavy bleeding or oozing from wounds
- unexpected or unusually heavy menstrual bleeding
- blood in the urine
- cloudy or dark urine
- painful or difficult urination or sudden decrease in amount of urine
- black, tarry, or bloody stools
- coughing up blood
- vomiting blood or something that looks like coffee grounds
- pain or swelling in the stomach or abdomen
- back pain
- stiff, swollen, or painful joints
- painful, bluish or purplish fingers or toes
- puffy or swollen eyelids, face, feet, or lower legs
- changes in the color of the face
- skin rash, itching, or hives
- yellow eyes or skin
- severe or continuing headache
- sore throat and fever, with or without chills
- breathing problems or wheezing
- tightness in the chest
- unusual tiredness or weakness
- weight gain
In addition, patients taking anticoagulant drugs should check with their physicians as soon as possible if any of these side effects occur:
- nausea or vomiting
- stomach pain or cramps
Other side effects may occur. Anyone who has unusual symptoms while taking anticoagulant drugs should get in touch with the prescribing physician.
Anticoagulants may interact with many other medications. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be increased. Anyone who takes anticoagulants should inform the prescribing physician about other prescription or nonprescription (over-the-counter) medicines he or she is taking—even aspirin, laxatives , vitamins, and antacids.
Diet also affects the way anticoagulant drugs work in the body. A normal, balanced diet should be followed every day while taking such medication. No dietary changes should be made without informing first the prescribing physician, who should also be told of any illness or other condition interfering with the ability to eat normally. Diet is a very important consideration because the amount of vitamin K in the body affects how anticoagulant drugs work. Dicoumarol and warfarin act by reducing the effects of vitamin K, which is found in meats, dairy products, leafy, green vegetables, and some multiple vitamins and nutritional supplements. For the drugs to work properly, it is best to have the same amount of vitamin K in the body all the time. Foods containing vitamin K should not be increased or decreased without consulting with the prescribing physician. If the patient takes vitamin supplements, he or she should check the label to see if it contains vitamin K. Because vitamin K is also produced by intestinal bacteria, a severe case of diarrhea or the use of laxatives may also alter a person's vitamin K levels.
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Nancy Ross-Flanigan Sam Uretsky