Anticoagulant Therapy: 5 Things You Need to Know

Pharmaceutical products that decrease the body’s capability to make blood clots are classified as anticoagulants. These drugs inhibit the liver’s vitamin K production. As a result, blood clotting occurs at a slower rate. Though they are also known as blood thinners; however, the blood will not actually become thin because of them. Clots that are already formed will not be dissolved when these drugs are taken. However, it can help prevent existing clots from increasing their size. Read for information about anticoagulant therapy.

When Are Anticoagulants Required?

Doctors typically prescribe anticoagulants as a treatment when blood clots are already formed. It can also be prescribed as a preventive measure, if there is a high risk of blood clotting. Individuals who have a high risk of developing blood clots include:

  • Those suffering from atrial fibrillation or an irregular and fast heart rate
  • Those who have an artificial heart valve
  • Those with endocarditis or an infection of the heart’s inner lining
  • Those with mitral stenosis (when a heart valve is unable to completely open)
  • Those with antiphospholipid syndrome and hereditary thrombophilia. These are blood diseases that influence the body’s blood clotting process.
  • Those who had a knee or hip replacement surgery

The Commonly Used Anticoagulants

Warfarin, Acenocoumarol and Phenindione

Today, the most widely used blood thinner is warfarin. In rare occasions, phenindione and acenocoumarol are also prescribed. Typically, this only happens when an individual cannot take warfarin. An example is when an individual has an allergic reaction to warfarin.

Dabigatran

Until recently, dabigatran has not been widely prescribed like warfarin. However, from this time forth, this drug will be frequently prescribed as national guidance has recommended it as an option for patients suffering from a certain kind of atrial fibrillation. As stated by the National Institute for Health and Care Excellence (NICE), dabigatran etexilate should be an option if you have non-valvular atrial fibrillation along with one or more of the following conditions: 

  • You have/had an embolism, stroke or transient ischemic attack (mini-stroke).
  • Less blood is pumped by your heart than normal.
  • You have symptoms of mild chest pain, dyspnea (shortness of breath) and minor limitations while doing ordinary activities.  
  • You are 75 years old or above.
  • You are 65 years old or above and have medical conditions such as hypertension, diabetes and coronary artery disease.

Apixaban and Rivaroxaban

Compared to warfarin, apixaban and rivaroxaban are not commonly prescribed, until recently. Similar to dabigatran, these two drugs will now be prescribed more frequently as these two are also recommended by national guidance as an option for certain kind of atrial fibrillation. As stated by the National Institute for Health and Care Excellence (NICE), either apixaban or rivaroxan can now be used as an anticoagulant therapy option for non-valvular atrial fibrillation along with one of the following conditions:

  • You are suffering from congestive heart failure.
  • You have hypertension.
  • You are 75 years old or above.
  • You have a history of a transient ischemic attack or stroke.
  • You have diabetes.

The Common Side Effect of Anticoagulants

When taking anticoagulants, you may experience several side effects. However, bleeding is considered as the primary side effect for all kinds of anticoagulants. It is imperative that all individuals taking phenindione, acenocoumarol and warfarin should have regular blood tests. This is done to measure the time it takes for the blood to clot.

If you are bleeding or bruising easily, this may indicate that you are taking excessive doses of anticoagulants. Another sign is that the bleeding does not stop as quickly as it normally did. If you experience any of the side effects listed below while you are taking anticoagulant therapy, you should immediately seek medical attention and undergo blood testing: 

  • The presence of blood in feces or urine. The color of blood in your feces may be bright red. A plum or black-colored feces may suggest that there is bleeding in your small intestine or stomach. 
  • In women, heavy bleeding during menses or other types of heavy bleeding from vagina
  • Severe bruising
  • A nosebleed that lasts for more than 10 minutes
  • The presence of blood in the vomit
  • The presence of blood in the sputum

The Vital Things to Consider When Taking Anticoagulants

When you are taking anticoagulants, it is important to consider the following:

Drug interactions may occur if you are taking an anticoagulant with other drugs. For this reason, your doctor should know everything about the medications you are currently taking, including the over-the-counter (OTC) drugs and supplements.

  • When you are taking warfarin, you will be given a yellow booklet. Always carry this anywhere you go. If there is an emergency, the attending physician will be able to know that you are taking warfarin, including the dose.
  • There may be a need for you to temporarily discontinue your anticoagulant therapy if you will undergo surgical or invasive procedures.
  • You should always inform your dentist about the anticoagulant you are taking. Although most dental procedures will not lead to uncontrollable bleeding, there are some procedures where bleeding can occur such as surgery and tooth extractions. During these kinds of procedures, you will have to temporarily discontinue taking blood thinners.
  • Your alcohol intake should not go beyond two units per day and avoid binge drink.
  • As much as possible, you should avoid any activities that may result in bruising, cuts and abrasions such as contact sports. You can be put at risk of bleeding with simple activities such as sewing and gardening. You should always be careful and wear some protection when getting involved in activities which can cause bleeding. 
  • When shaving or brushing your teeth, be very careful to avoid getting cuts or bleeding gums. You can use soft bristle brushes or electric razors.
  • Insect bites should be avoided. An insect repellent can be useful.

Individuals Who Are Not Allowed to Take Anticoagulants

Anticoagulants should not be taken if:

  • You are pregnant.
  • You have peptic ulcer.
  • You have bleeding in the brain (hemorrhagic stroke).
  • You are taking drugs that may interact with anticoagulants.
  • You have a major bleeding that is left untreated.
  • You are having a surgery and the risk of bleeding is high.
  • You have a blood pressure that is very high.
  • Your kidney function is severely reduced – only for dabigatran.

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