ANTICOAGULANTS; General Considerations

8/7/2019 ANTICOAGULANTS; General Considerations

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ANTICOAGULANTS &

ANTIPLATELETS

PROF DR SHAH MURAD

[email protected]


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Anticoagulants are drugs used to prevent clotformation or to prevent a clot that has formedfrom enlarging.

They inhibit clot formation by blocking theaction of clotting factors or platelets.


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Anticoagulant drugs fall into threecategories:

1) inhibitors of clotting factor synthesis,

2) inhibitors of thrombin and

3)

antiplatelet drugs.


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Anticoagulant drugs reduce the ability of theblood to form clots.

Although blood clotting is essential to prevent>>>>> serious bleeding in the case of skincuts, < clots inside theblood vessels block the flow of blood to majororgans and cause heart attacks and strokes.


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Although these drugs are sometimescalled blood thinners, they do notactually thin the blood.


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This type of medication will not dissolve clotsthat already have formed, although the drugstops an existing clot from worsening.

However, another type of drug, used inthrombolytictherapy, will dissolve existingclots.


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they may be given to prevent blood clots fromforming after the replacement of a heart valveor to reduce the risk of a stroke or anotherheartattack after a first heart attack.


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They are also used to reduce thechance of blood clots forming duringopen heart surgery or heart bypasssurgery.


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Low doses of these drugs may be given toprevent blood clots in patients who must stay

in bed for a long time after certain types ofsurgery.

Because anticoagulants affect the blood'sability to clot, they can increase the risk ofsevere bleeding and heavy blood loss.

It is thus essential to take these drugs exactlyas directed after all necessary investigations


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Anticoagulant drugs fall into three groups:

Inhibitors of clotting factor synthesis. Theseanticoagulants inhibit the production of certainclotting factors in the liver.

One example is warfarin (brand name:coumadin).


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Antiplatelet drugs These drugs interact with platelets, which is a

type of blood cell, to block platelets fromaggregating into harmful clots.

They include: aspirin, ticlopidine (Ticlid),clopidogrel (Plavix), tirofiban (Aggrastat), andeptifibatide (Integrilin).


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Recommendeddosage

The recommended dosage depends onthe type of anticoagulant drug and themedical condition for which it isprescribed.

Dose is adjusted after checking thepatient's clotting time.


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Taking too much of thismedicationcancausesevere bleeding. Anticoagulantsshouldalsobetakenonschedule.

However, apatientwho forgetstotake a

misseddose untilthe nextday shouldnottakethe misseddose atallandshouldnotdoublethe nextdose, asthiscouldleadtobleeding.


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Precautions

Periodic blood tests must be done tocheck the blood's clotting ability.

The results of these tests will help todetermine the proper amount ofmedication to be taken each day.


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Time is required for normal clotting ability to returnafter anticoagulant treatment.

During this period, patients must observe the sameprecautions they observed while taking the drug.

The length of time needed for the blood to return tonormal depends on the type of anticoagulant drugthat was taken.


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People who are taking anticoagulant drugsshould tell all physicians, dentists,

pharmacists, and other medical professionalswho provide medical treatments or servicesto them that they are taking such amedication.

They should also carry identification statingthat they are using an anticoagulant drug.


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Other prescription drugs or over-the-counter medicineespecially aspirinshould not be taken without theprescribing physician being informed.

Because of the risk of heavy bleeding,anyone who takes an anticoagulant drugmust take care to avoid injuries.


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Special care should be taken in shaving and inbrushing and flossing the teeth.

Soft toothbrushes should be used and theflossing should be very gentle.

Electric razors should be used instead of ablade.


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Alcohol can change the wayanticoagulant drugs affect the body.

Anyone who takes this medicine should

not have more than one to two drinksat any time and should not drink alcoholevery day.


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Specialconditions

People with specific medical conditionsor who are taking certain other

medicines can have problems if theytake anticoagulant drugs.

Before taking these drugs, theprescribing physician should beinformed about any of these conditions


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ALLERGIES:

Anyone who has had unusual reactions toanticoagulants in the past should let his or

her physician know before taking the drugsagain.

The physician should also be told about anyallergies to beef, pork, or other foods; dyes;preservatives; or other substances.


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PREGNANCY

Anticoagulants may cause many seriousproblems if taken during pregnancy.

Birthdefects, severe bleeding in thefetus, and other problems that affect

the physical or mental development ofthe fetus or newborn are possible.


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The mother may also experience severebleeding if she takes anticoagulants during

pregnancy, during delivery, or even shortlyafter delivery.

Women should not take start taking

anticoagulants during pregnancy and shouldnot become pregnant while taking it.


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BREASTFEEDING:

Some anticoagulant drugs may pass intobreast milk.

Blood tests can be done on nursing babies tosee whether the drug is causing anyproblems.

If it is, other medication may be prescribed tocounteract the effects of the anticoagulant

drug.


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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 theyare being treated by any other medicalphysician or dentist.


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In addition, people who will be takinganticoagulant drugs should let their

physician know if they have recentlyhad any of the following:


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fever lasting more than one to two days

severe or continuing diarrhea

childbirth heavy or unusual menstrual bleeding

insertion of an intrauterine contraceptive device(IUD)

falls, injuries, or blows to the body or head

any type of surgery, including dental surgery

spinal anesthesia

radiation treatment


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USE OF CERTAIN FOODS AND

MEDICINES

Many foods and drugs may affect theway the anticoagulant drugs work or

may increase the risk of side effects.


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Sideeffects

The most common minor side effects arebloating or gas.

These problems usually go away as the bodyadjusts to the drug and do not require medicaltreatment.

More serious side effects may occur, especiallyif excessive anticoagulant is taken.

bleeding gums


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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 menstrual bleeding


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blood in the urine

cloudy or dark urine

painful or difficult urination or suddendecrease in amount of urine

black, tarry, or bloody stools


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coughing up blood

vomiting blood or something that lookslike coffee grounds

constipation


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pain or swelling in the stomach orabdomen

back pain

stiff, swollen, or painful joints

painful, bluish or purplish fingers ortoes


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puffy or swollen eyelids, face, feet, orlower legs

changes in the color of the face

skin rash, itching, or hives

yellow eyes or skin


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severe or continuing headache

sore throat and fever, with or without chills

breathing problems or wheezing

tightness in the chest

dizziness

unusual tiredness or weakness weight gain


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nausea or vomiting

diarrhea

stomach pain or cramps


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DD Interactions

Anticoagulants may interact with manyother medications. When this happens,

the effects of one or both of the drugsmay change or the risk of side effectsmay be increased.


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Anyone whotakesanticoagulantsshouldinformthe prescribingphysicianaboutother

prescriptionornonprescription (over-the-countermedicines)he orshe istakingevenaspirin,laxatives,vitamins,andantacids.


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Diet also affects the way anticoagulantdrugs work in the body.

A normal, balanced diet should befollowed every day while taking such

medication.


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Diet is a very important considerationbecause the amount of vitamin K in the

body affects how anticoagulant drugswork.

Dicoumarol and warfarin act by

reducing the effects of vitamin K.


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Vitamin K is found in meats, dairyproducts, leafy, green vegetables, and

some multiple vitamins and nutritionalsupplements


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For the drugs to work properly, it isbest to have the same amount of

vitamin K in the body all the time.


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If the patient takes vitamin supplements, heshould check the label to see if it contains

vitamin K.

Because vitamin K is also produced by

intestinal bacteria, a severe case of diarrheaor the use oflaxatives may also alter aperson's vitamin K levels


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KEY TERMS

AnticoagulantDrug used to prevent clotformation or to prevent a clot that has formed

from enlarging.

Anticoagulant drugs inhibit clot formation by

blocking the action of clotting factors orplatelets. Anticoagulant drugs fall into threegroups: inhibitors of clotting factor synthesis,

inhibitors of thrombin and antiplatelet drugs.


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AntiplateletdrugDrug that inhibitsplatelets from aggregating to form a

plug. They are used to prevent clottingand alter the natural course ofatherosclerosis.

AtherosclerosisConditioncharacterized by deposits of fattyplaque in the arteries.


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ClotA soft, semi-solid mass thatforms when blood gels.

PlateletA small, disk-shaped body inthe blood that has an important role inblood clotting: they form the initial plug

at the rupture site of a blood vessel.


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ThrombinThrombin is a protein producedby the body.

It is a specific clotting factor that plays animportant role in the blood clotting process.

ThrombininhibitorThrombin inhibitors are

one type of anticoagulant medication, used tohelp prevent formation of harmful blood clotsin the body by blocking the activity of

thrombin

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ANTICOAGULANTS; General Considerations