Anticoagulant Therapy What is anticoagulant therapy ? Anticoagulant therapy refers to the use of certain drugs to prevent formation of harmful blood clots. They are commonly referred to as "blood thinners”.
Individuals at high risk for thromboembolic events (thrombosis and embolism) are potential candidates for receiving anticoagulant therapy, among them : • SurgeryPatients • DialysisPatients • BedriddenPatients • These medications are used on a daily basis or episodically.
Note that anticoagulants cannot break up clots that have already formed; the "clot-busters" used in the management of a heart attack are a different type of drug.
What is thrombosis ? • Thrombosis refers to formation of a blood clot (or thrombus) in the cardiovascular system . • Atherosclerotic damage (deposits of fatty plaque in the arteries) can trigger thrombosis .
If thrombosis occurs on a plaque-lined coronary artery (artery supplying blood to the heart) or travels there after forming in a leg vein, blood flow to the heart may be cut off, resulting in a heart attack. • If a blood clot forms in an artery of the brain, stroke can occur.
What is embolism? • Embolism occurs when a blood clot forms in one part of the body, then travels through the bloodstream to another part of the body. (The traveling blood clot is referred to as an embolus.) • If an embolus lodges in a coronary artery, a heart attack can occur. • If an embolus lodges in an artery of the brain, stroke can occur. • Pulmonary embolism, a life-threatening condition, occurs when an embolus lodges in the lungs.
How do anticoagulant drugs work ؟ • The process of blood clot formation involves a series of interactions amongst clotting factors (proteins present in the blood) and platelets (a type of blood cell). Anticoagulant drugs inhibit clot formation by blocking the action of clotting factors or platelets. • There different types of anticoagulant drugs. Some block the action of proteins necessary for blood to clot, while others interfere with production of those clotting substances in the first place.
What are the different types of anticoagulant drugs? • Anticoagulant drugs fall into three groups: • Inhibitors of Clotting Factor Synthesis (interfere with production of certain proteins made by the liver that are integral to coagulation) • Inhibitors of Thrombin (a specific clotting factor with a pivotal role in the clotting process) • Inhibitors of Platelets
Inhibitors of Clotting Factor Synthesis include: • Warfarin (brand name: Coumadin) Thrombin Inhibitors include: • Heparin (sold under a variety of brand names) • Lepirudin (Refludan)
Antiplatelet Drugs include: • Aspirin • Ticlopidine (Ticlid) • Clopidogrel (Plavix) • Tirofiban (Aggrastat) • Eptifibatide (Integrilin)
What are the potential side-effects of anticoagulant drugs? • Each drug has certain distinct side-effects. • A risk common to all anticoagulants, however, is hemorrhage (excessive bleeding), a potentially disabling or life-threatening occurrence. • As a result, anticoagulation drugs should be used only with great caution (when potential benefits outweigh risks), or should not be used at all, in patients at increased risk for bleeding.
Some of the factors which increase risk for bleeding include: • History of Bleeding in the Brain • History of Brain Tumor • History of Cerebral Aneurysm • Recent Internal Bleeding (such as bleeding peptic ulcer) • Recent Stroke • Recent Major Surgery or Injury • Bleeding Disorder (such as hemophilia or von Willebrand disease)
Low Platelet Count • High Blood Pressure (uncontrolled) • Severe Kidney Damage • Severe Liver Damage • Diabetes (severe) • Blood Vessel/Organ Abnormalities
What are the symptoms of hemorrhage؟ • Depending upon the location of the bleed, signs of hemorrhage can include one or more of the following: Pain (located in the stomach, back, or joints). • Swelling or Discomfort • Prolonged Bleeding from Cuts.
Unusually Heavy Menstrual Flow or Other Vaginal Bleeding • Nosebleeds • Gum Bleeding • Excessive Bruising • Red or Dark-Brown Urine • Red or Black Stools • Headaches • Dizziness • Weakness • Headaches • Constipation
How can I protect myself from dangerous bleeding? • Take anticoagulant drugs exactly as prescribed; do not change medication time or dosage without first consulting ahealthcare provider. Anticoagulant drugs can interact with one another, as well as with other medications.
Therefore, review all current medications--bothprescriptionandover-the-counter--with a healthcare provider. Do not start any new medication without first consulting a healthcare provider. • Because of the increased risk of bleeding with anticoagulant drugs, other doctors need to know if the patient is on a blood thinner.
Other medical procedures that put a patient on a blood thinner at risk of bleeding are: • SpinalAnesthesia • Radiation Therapy • It may be necessary to discontinue anticoagulation therapy for a period of time before and after surgery .
Women Should Tell Their Doctor If It Is Possible They ArePregnant • Wear or Carry Medical Identification (stating that an anticoagulant drug is taken.(
The doctor who prescribed the anticoagulant will arrange for the patient to be monitored by periodic testing of blood clotting capability. • Keep All Appointments for Check-Ups. • [Note: In some cases it is now possible for individuals to conduct testing at home.]