They are divided into natural anticoagulants and synthetic ones. The former are produced in the body, the latter are produced artificially and are used in medicine as medicines.

Natural

They can be physiological and pathological. Physiological anticoagulants are normally present in plasma. Pathological ones appear in the blood in some diseases.

Physiological anticoagulants are divided into primary and secondary. Primary ones are synthesized by the body independently and are constantly in the blood. Secondary ones are formed during the breakdown of coagulation factors during the formation of fibrin and its dissolution.

Primary natural anticoagulants

They are usually divided into groups:

1. Antithromboplastins.
2. Antithrombins.
3. Inhibitors of fibrin self-assembly.

When the level of primary physiological anticoagulants in the blood decreases, there is a risk of developing thrombosis.

This group of substances includes:

• Heparin. It is a polysaccharide synthesized in mast cells. It is found in significant quantities in the lungs and liver. IN large doses ah interferes with the blood clotting process at all stages, suppresses a number of platelet functions.
• Antithrombin III. Synthesized in the liver, it belongs to alpha₂-glycoproteins. Reduces the activity of thrombin and some activated coagulation factors, but does not affect non-activated factors. The anticoagulant activity of plasma is 75% provided by antithrombin III.
• Protein C. It is synthesized by liver parenchyma cells and is in an inactive form in the blood. Activated by thrombin.
• Protein S. Synthesized by endothelial cells and liver parenchyma (hepatocytes), depends on vitamin K.
• Alpha₂-macroglobulin.
• Antithromboplastins.
• Contact inhibitor.
• Lipid inhibitor.
• Complement inhibitor-I.

Secondary physiological anticoagulants

As already mentioned, they are formed during the process of blood clotting and the dissolution of fibrin clots during the breakdown of certain coagulation factors, which, due to degradation, lose their coagulation properties and acquire anticoagulation properties. These include:

• Antithrombin I.
• Antithrombin IX.
• Metafactors XIa and Va.
• Febrinopeptides.
• Auto-II anticoagulant.
• Antithromboplastins.
• PDF are products formed during the breakdown (degradation) of fibrin under the influence of plasmin.

Pathological anticoagulants

In some diseases, specific antibodies can form and accumulate in the blood, preventing blood clotting. They can be produced against any coagulation factors, but inhibitors of factors VIII and IX are most often produced. For some autoimmune diseases pathological proteins appear in the blood that have an antithrombin effect or suppress coagulation factors II, V, Xa.

Anticoagulant drugs

Artificial anticoagulants, of which a large number have been developed, are indispensable drugs in modern medicine.

Indications for use

Indications for taking oral anticoagulants are:

• myocardial infarction;
• pulmonary infarctions;
• heart failure;
• thrombophlebitis of the leg veins;
• thrombosis of veins and arteries;
• varicose veins;
• thrombotic and embolic strokes;
• embolic vascular lesions;
• chronic aneurysm;
• arrhythmias;
• artificial heart valves;
• prevention of atherosclerosis of blood vessels in the brain, heart, and peripheral arteries;
• mitral heart defects;
• thromboembolism after childbirth;
• prevention of thrombosis after surgery.

Heparin is the main representative of the class of direct anticoagulants

Classification of anticoagulants

Medicines in this group are divided into direct and indirect depending on the speed and mechanism of action, as well as the duration of the effect. Direct directly affect blood clotting factors and inhibit their activity. Indirect ones act indirectly: they slow down the synthesis of factors in the liver. Available in tablets, injection solutions, and ointment form.

Direct

Medicines in this group act directly on coagulation factors, which is why they are called fast-acting drugs. They prevent the formation of fibrin threads, prevent the formation of blood clots and stop the growth of existing ones. They are divided into several groups:

• heparins;
• hirudin;
• low molecular weight heparin;
• sodium hydrogen citrate;
• danaparoid, lepirudin.

Heparin ointment is excellent against bruises and is used to treat thrombophlebitis and hemorrhoids

This is the most famous and widespread direct-acting anticoagulant. It is administered intravenously, subcutaneously and intramuscularly, and is also used as a topical ointment. Heparin-type drugs include:

Topical heparins have low tissue permeability and are not very high efficiency. Used to treat varicose veins of the legs, hemorrhoids, and bruises. The most well-known and often used are the following heparin products:

Lyoton is a popular heparin-containing agent for external use for varicose veins.

Heparins for intravenous and subcutaneous administration– a large group of medications that are selected individually and are not replaced by one another during the treatment process, since they are not equivalent in action. The activity of these drugs reaches its maximum after about three hours, and the effect continues throughout the day. These heparins reduce the activity of tissue and plasma factors, block thrombin, prevent the formation of fibrin threads, and prevent platelet aggregation.

For the treatment of deep vein thrombosis, heart attack, pulmonary embolism, and angina, Nadroparin, Enoxaparin, and Deltaparin are usually prescribed.

To prevent thromboembolism and thrombosis, Heparin and Reviparin are prescribed.

This anticoagulant is used in laboratory practice. To prevent blood from clotting, it is added to test tubes. It is used for the preservation of blood and components.

Indirect

They reduce the production of certain coagulation factors in the liver (VIII, IX, X, prothrombin), slow down the formation of proteins S and C, and block the production of vitamin K.

These include:

1. Indan-1,3-dione derivatives. Representative - Fenilin. This oral anticoagulant is available in tablets. Its action begins 8 hours after administration, reaching maximum effectiveness within a day. During administration, it is necessary to monitor the prothrombin index and check the urine for the presence of blood in it.
2. Coumarin. IN natural environment Coumarin is found in plants (bison, sweet clover) in the form of sugars. For the first time, its derivative, dicoumarin, which was isolated in the 20s of the 20th century from clover, was used to treat thrombosis.

Indirect anticoagulants include the following drugs:

Warfarin should not be taken in case of certain kidney and liver diseases, thrombocytopenia, acute bleeding and tendency to bleed, during pregnancy, lactase deficiency, congenital deficiency of proteins C and S, disseminated intravascular coagulation syndrome, if the absorption of galactose and glucose is impaired.

Warfarin is the main representative of the class of indirect anticoagulants

Side effects include abdominal pain, vomiting, diarrhea, nausea, bleeding, urolithiasis, nephritis, alopecia, allergies. A skin rash, itching, eczema, and vasculitis may appear.

The main disadvantage of Warfarin is the high risk of bleeding (gastrointestinal, nasal and others).

New generation oral anticoagulants (NOACs)

Modern anticoagulants - indispensable means for the treatment of many diseases, such as heart attacks, thrombosis, arrhythmias, ischemia and many others. Unfortunately, drugs that have proven to be effective have many side effects. But developments do not stop, and new oral anticoagulants periodically appear on the pharmaceutical market. PLAs have both advantages and disadvantages. Scientists are trying to obtain universal remedies that can be taken for various diseases. Drugs are being developed for children, as well as for patients who need them. at the moment contraindicated.

New anticoagulants have the following advantages:

• when taking them, the risk of bleeding is reduced;
• the effect of the medicine occurs within 2 hours and quickly ceases;
• the drugs can be taken by patients for whom Warfarin is contraindicated;
• the influence of other drugs and food consumed is reduced;
• inhibition of thrombin and thrombin-binding factor is reversible.

The new drugs also have disadvantages:

• many tests for each product;
• it is necessary to drink regularly, while old medications can be skipped due to their long-term effects;
• intolerance by some patients who had no side effects when taking the old pills;
• risk of bleeding in the gastrointestinal tract.

As for indirect anticoagulants, they have not yet been developed that are radically different from Warfarin, Dicumarin, and Sinkumar.

New drugs Apixaban, Rivaroxaban, Dabigatran may become an alternative for atrial fibrillation. Their main advantage is that they do not require constant blood donation while taking them, and they do not interact with other medications. At the same time, these drugs are just as effective and can prevent stroke due to arrhythmia. As for the risk of bleeding, it is either the same or lower.

What you need to know

Patients prescribed oral anticoagulants should be aware that they have a large number of contraindications and side effects. When taking these medications, you need to follow a diet and take additional tests blood. It is important to calculate your daily dose of vitamin K, since anticoagulants interfere with its metabolism; Regularly monitor laboratory indicators such as INR (or INR). The patient should know the first symptoms internal bleeding in order to seek help in time and change the drug.

Antiplatelet agents

Medicines in this group also help thin the blood and prevent the formation of blood clots, but their mechanism of action is different. Antiplatelet agents reduce blood clotting due to their ability to inhibit platelet aggregation. They are prescribed to enhance the effect of anticoagulants. In addition, they have an antispasmodic and vasodilating effect. The most popular antiplatelet agents:

• Aspirin is the most famous of this group. It is considered very effective means, dilates blood vessels, thins the blood and prevents the formation of blood clots.
• Tirofiban – prevents platelet aggregation.
• Ticlopidine is indicated for cardiac ischemia, heart attacks, and for the prevention of thrombosis.
• Dipyridamole is a vasodilator.
• Eptifibatitis – blocks platelet aggregation.

Aspirin is the most famous representative of the group of antiplatelet drugs

A new generation of drugs includes the drug Brilint with the active substance ticagrelor. It is a reversible antagonist of the P2Y receptor.

Natural blood thinners

Adherents of traditional treatment methods use herbs with a blood-thinning effect to prevent thrombosis. The list of such plants is quite long:

• horse chestnut;
• willow bark;
• mulberry;
• sweet clover;
• wormwood;
• meadowsweet:
• red clover;
• licorice root;
• evasive peony;
• chicory and others.

Before using herbs, it is advisable to consult a doctor: not all plants can be beneficial.

Red clover is used in folk medicine as a means to improve blood flow.

Conclusion

Anticoagulants are indispensable drugs for treatment cardiovascular pathologies. You cannot take them on your own. They have many contraindications and side effects, and uncontrolled reception These medications can lead to bleeding, including hidden bleeding. They should be prescribed and the dosage determined by a doctor who is able to take into account all the features of the course of the disease and possible risks. During treatment, regular laboratory monitoring is required.

It is important not to confuse anticoagulants and antiplatelet agents with thrombolytic agents. The main difference is that the former cannot destroy a blood clot, but only prevent or slow down its development. Thrombolytics are intravascular drugs that dissolve blood clots.

In one case, it is indicated that chicory, along with greens, should be removed from the diet, and chicory is named in the list of natural remedies (coagulants). So how do you know whether it can be taken in parallel with warfarin or not?

List of drugs - direct and indirect anticoagulants, blood thinners

In a healthy human body, the blood coagulation and anticoagulation systems are in dynamic equilibrium. At the same time, the flow of blood through the vessels is not hampered, and there is no excessive thrombus formation, both during open bleeding and inside the vascular bed.

When this balance is disturbed, conditions are created for small or large vessels or even the development of disseminated intravascular coagulation syndrome, in which multiple blood clots can lead to rapid death.

However, a number of clinical situations lead to blood clots forming in the wrong place and at the wrong time, clogging veins and arteries of different sizes.

Diseases in which coagulability is increased

Acute venous thrombosis

• Against the background of varicose veins of the lower extremities, phlebitis as a postoperative complication
• Thrombosis of hemorrhoidal veins
• Thrombosis in the inferior vena cava system

Acute arterial thrombosis

• Thromboembolism pulmonary artery(TELA)
• Ischemic stroke
• Myocardial infarction
• Acute injuries of the arteries of the lower extremities against the background of atherosclerosis, inflammation, vascular injury

Disseminated intravascular coagulation syndrome due to:

• injuries
• sepsis due to the release of a large number of blood clotting factors from tissues.

Treatment of all of these pathologies involves the use of anticoagulants, which are also called anticoagulants or blood thinners. These are medications designed to reduce blood clotting and thereby restore its fluidity ( rheological properties) and reduce the risk of recurrent thrombosis. Anticoagulants reduce the activity of tissue (fibrinogen, platelets) or plasma coagulation factors. The effect of anticoagulants can be:

• direct - direct anticoagulants
• indirect - indirect anticoagulants

Prevention of heart diseases - in addition to the treatment of acute thrombosis, treatment with anticoagulants is carried out for their prevention in unstable angina, various violations heart rate (permanent form atrial fibrillation), with heart valve defects, obliterating endarteritis, for patients on hemodialysis, after recovery operations not the heart (eg, coronary artery bypass grafting).

The third area of ​​use of anticoagulants is the stabilization of blood components when taken for laboratory research or preparing them for subsequent transfusion.

Direct anticoagulants

Topical heparins

They are characterized by low tissue permeability and a weaker effect. Used for local treatment varicose veins, hemorrhoids, resorption of hematomas. List: Heparin ointment, Venolife, Lyoton gel, Venitan, Laventum, Trombless.

• Heparin ointment

• Lyoton gel

• Trombless gel

• Lavenum gel

• Venolife

(Heparin + Dexpanthenol + Troxerutin) 40g. 400 rub.

• Hepatrombin

Heparin+ Allantoin+ Dexpanthenol 40g. 300IU ointment 50 rubles, 500IU 40g. gel 300 rub.

• Venitan Forte gal

(heparin+escin) price 50 g. 250 rub.

• Troxevasin NEO

(Heparin + Dexpanthenol + Troxerutin) 40 gr. 280 rub.

Heparins for intravenous and subcutaneous administration

The second large group of direct anticoagulants are heparins, the mechanism of action of which is based on a combination of inhibition of plasma and tissue coagulation factors. On the one hand, these direct anticoagulants block thrombin and inhibit fibrin formation.

On the other hand, they reduce the activity of plasma coagulation factors (IXa, Xa, XIa, XIIa) and kallikrein. In the presence of antithrombin III, heparin binds to plasma proteins and neutralizes clotting factors. Heparins destroy fibrin and inhibit platelet adhesion.

The drugs are administered subcutaneously or intravenously (depending on the instructions). During treatment, one drug does not change to another (that is, the drugs are not equivalent and are not interchangeable). The maximum activity of the drug develops after 2-4 hours, and activity persists throughout the day.

• Low molecular weight heparins

They have less effect on thrombin, predominantly inhibiting coagulation factor Xa. This improves the tolerability and effectiveness of low molecular weight heparins. They reduce platelet aggregation less than low molecular weight heparin anticoagulants. List of drugs:

• Fraxiparine

(Nadroparin calcium) 1 syringe 380 rub.

• Hemapaxan

(Enoxaparin sodium) 0.4 ml. 6 pcs. 1000 rub.

• Clexane

(Enoxaparin sodium) 0.4 ml 1 spr. 350 rub., Anfiber, Enixum

(Deltaparin sodium) 2500IU 10 pcs. 1300 rub. 5000IU 10 pcs 1800 rub.

• Klivarin

• Troparin

• Medium molecular weight heparins

These are the sodium and calcium salts of heparin. Heparin, Heparin Ferein 5 amp.rub.

How are heparins selected?

• For the prevention of thrombosis and thromboembolism (including postoperative ones), Klivarin and Troparin are preferred.
• For the treatment of thrombotic complications (unstable angina, heart attack, pulmonary embolism, deep vein thrombosis) - Fraxiparine, Fragmin, Clexane.
• For the prevention of thrombosis in patients on hemodialysis: Fraxiparine, Fragmin.

Cybernine – antithrombin III drug

Its action is similar to heparin: it blocks thrombin, coagulation factors IXa to XIIa, and plasmin. During treatment, the level of antithrombnia III in the blood plasma should be monitored.

Indications: The drug is used for thromboembolic complications due to congenital deficiency of antithrombin III or its acquired deficiency (against the background of liver cirrhosis with hepatic cell failure and severe jaundice, with disseminated intravascular coagulation syndrome, in patients receiving hemodialysis, with thromboembolism of different origins). The drug is prescribed intravenously.

Contraindications: Cybernine is not used in children intolerant to it. Use with caution in pregnant women.

Side effects: Its use may be complicated skin allergies(urticaria), dizziness, breathing problems, chills, fever, bad taste in the mouth, blurred vision, cough, chest pain.

Direct acting antithrombotics

They work by directly blocking thrombin (a plasma clotting factor that is formed from prothrombin activated by thromboplastin). The drugs in this group work similarly to hirudin, secreted by leeches and preventing blood clotting.

• Recombinant natural hirudins (Desirudin, Lepirudin) block the active region of thrombin and fibrin.
• The mechanism of action of synthetic hirudin (Bivalirudin) is similar to them.
• Melagatran and Efegatran carry out an isolated covalent blockade of the active part of thrombin.
• Argatroban, Dabigatran, Ximelagatran, Inogatran, Etexipat carry out an isolated non-covalent blockade of thrombin.

Has been associated with Ximelagatran high hopes in the prevention of strokes. In experiments, it showed decent results and was not inferior in effectiveness and bioavailability to Warfarin. However, further information was accumulated that the drug causes serious damage liver, especially with prolonged use.

Fondaparinux (Arixtra) is a direct-acting parenteral anticoagulant that selectively inhibits coagulation factor Xa. It can be administered subcutaneously without APTT monitoring in standard doses, taking into account the patient’s body weight. The average dose is 2.5 mg per day.

The drug is excreted mainly by the kidneys, unchanged.

Used to prevent thromboembolic complications in patients undergoing major surgical interventions abdominal cavity, in long-term immobilized patients or patients undergoing joint replacement. The drug is used to treat acute thrombosis deep veins of the lower extremities, pulmonary embolism, acute coronary syndrome.

The next direct anticoagulant is sodium hydrocytart

It is used exclusively for the preservation of blood and its components. This is what is added to test tubes with blood in the laboratory to prevent it from clotting. By binding free calcium ions, sodium hydrogen citrate prevents the formation of thromboplastin and the conversion of prothrombin to thrombin.

Indirect anticoagulants

Indirect anticoagulants are drugs that have the opposite effect of vitamin K. They either reduce the formation of proteins (proteins C and S) involved in the anticoagulant system, or impede the formation of prothrombin, VII, IX and X coagulation factors in the liver.

Indan-1-3dione derivatives are represented by Phenilin (Phenidion)

• The drug is available in tablets of 0.03 grams (20 pieces, 160 rubles).
• The drug works within 8-10 hours of administration. The maximum effect occurs after an hour. It accumulates in the body less than warfarin and does not produce the effect of the total dose. Less effect on capillaries. Prescribed under the supervision of PTI.
• It is prescribed one tablet in four doses on the first day, on the second day one tablet in three doses, then one tablet per day (depending on the level of IPT). In addition to monitoring IPT, urine tests should be performed to check for the appearance of red blood cells.
• Doesn't go well with hypoglycemic agents(Butamide).

Coumarin derivatives

In nature, coumarin in the form of sugars is found in many plants (aster, sweet clover, bison). In its isolated form, these are crystals that smell like fresh hay. Its derivative (dicoumarin) was isolated in 1940 from rotting sweet clover and was first used to treat thrombosis.

This discovery of pharmacists was prompted by veterinarians who, in the 20s of the last century, discovered that cows in the USA and Canada, grazing in meadows overgrown with clover, began to die from massive bleeding. After this, dicoumarin was used for some time as a rat poison, and later began to be used as an anticoagulant. medical drug. Subsequently, dicoumarin was replaced from pharmaceuticals by neodicoumarin and warfarin.

List of drugs: Warfarin (Warfarex, Marevan, Warfarin sodium), Neodicoumarin (Ethylbiscoumacetate), Acenocoumarol (Sincumar).

It should be remembered that independent initiation of use and selection of doses of Warfarin are strictly prohibited, due to the high risks of bleeding and strokes. Only a doctor who can competently assess the clinical situation and risks can prescribe anticoagulants and titrate doses.

The most popular indirect anticoagulant today is Wafarin.

Effect of the drug and indications for use

Warfarin is available under different commercial names in tablets of 2.5, 3 and 5 mg. If you start taking the tablets, they will begin to act after an hour, and the maximum therapeutic effect will appear by 5-7 days from the start of treatment. If the drug is discontinued, normal functioning of the blood coagulation system will return after 5 days. Indications for prescribing warfarin are most often all typical cases of thrombosis and thromboembolism.

Dosages

The drug is taken once a day at the same time. Start with 2 tablets per day ( daily dose 5 mg). Dose adjustment is carried out on days 2-5 after monitoring coagulation parameters (INR). Maintenance dosages remain within 1-3 tablets (2.5-7.5 mg) per day. The duration of taking the drug depends on the type of pathology. Thus, for atrial fibrillation and cardiac defects, the drug is recommended for continuous use; PE requires treatment for about six months (if it occurred spontaneously or its cause was eliminated surgically) or is carried out for life (if it occurred against the background of thrombophlebitis of the veins of the legs).

Side effects

Side effects of warfarin include bleeding, nausea and vomiting, diarrhea, abdominal pain, skin reactions (urticaria, skin itching, eczema, necrosis, vasculitis, nephritis, urolithiasis, hair loss).

Contraindications

Warfarin should absolutely not be used in acute bleeding, disseminated intravascular coagulation syndrome, severe liver or kidney diseases with creatinine more than 140 µmol per liter, thrombocytopenia, in persons with a predisposition to bleeding ( peptic ulcer, severe wounds, bacterial endocarditis, esophageal varices, hemorrhoids, arterial aneurysms), in the first 12 and last 4 weeks of pregnancy. Also, the drug is not recommended for impaired absorption of glucose and galactose, or for lactase deficiency. Warfarin is not indicated for congenital deficiency proteins S and C in blood plasma.

Simultaneous food intake:

There is a whole list of foods that should be consumed with caution or completely excluded during warfarin treatment, as they increase bleeding and increase the risk of bleeding. These are garlic, sage and quinine contained in tonics, papaya, avocado, onions, cabbage, broccoli and Brussels sprouts, cucumber peel, lettuce and watercress, kiwi, mint, spinach, parsley, peas, soybeans, watercress, turnips , olive oil, peas, cilantro, pistachios, chicory. Alcohol also increases the risk of bleeding.

St. John's wort, on the contrary, reduces the effectiveness of the medicine and should not be used simultaneously with it.

Medicines that are contraindicated with warfarin

NSAIDs (except COX-2 inhibitors), Clopidogrel, Aspirin, Dipyridamole, penicillins in high doses, Cimetidine, Chloramphenicol.

Medicines that increase the effect of warfarin

Allopurinol, Digoxin, Amiodarone, Quinidine, Disopyramide, Disulfiram, Amitriptyline, Sertraline, Heparin, Bezafibrate, Clofibrate, Fenofibrate, Vitamins A and E, Glucagon, Glibenclamide, Gingo bilboa, Flu vaccine, Ifosfamide, Methotrexate, Etoposide, Tegafur, lukast, Cimetidine, Indomethacin, Codeine, Metolazone, Piroxicam. Parksetine, Proguanil, Omeprazole, Simvastatin, Propafenone, Sulindac, Sulfapyrazone, Testosterone, Danazol, Tamoxifen, Fluoxetine, Troglitazone, Phenylbutazone, Flucanazole, Itraconazole, Levamisole, Miconazole, Lovastatin, Celecoxib, Cephalexin, Ciprofloxacin, Norfloxacin, Ofloxacin, mycin, Azithromycin, Tetracyclines, Cefuroxime, Clarithromycin, Chloramphenicol, Sulfamethoxazole.

What is INR and why should it be determined?

INR (International Normalized Ratio) is an indicator of blood clotting that is studied before prescribing warfarin and as a control for the effectiveness of therapy, as well as for adjusting dosages and assessing the risks of complications of treatment. This is a derivative of prothrombin time (during which the blood clots), like PTI (prothrombin index), which is normally %.

• INR is the ratio of the patient's prothrombin time to the standard prothrombin time. The higher the INR, the worse the blood clotting.
• The INR norm is 0.85-1.25. During warfarin therapy, you need to achieve an INR of 2-3

The INR is checked before starting warfarin, then on days 2-5. On average, it takes up to 10 days to select the dose of the drug and stabilize the INR within the target numbers (2-3). In the future, monitoring is carried out once every 2-4 weeks.

• If the INR is less than 2, the dose of warfarin is insufficient, it is increased by 2.5 mg (1 tablet per week), monitoring the INR every week until it reaches 2-3.
• If the INR is more than 3, then the dose of the drug is reduced (1 tablet 2.5 mg per week). INR monitoring is carried out one week after dose reduction.
• If the INR is 3.51-4.5, reduce the dose by 1 tablet. INR is monitored after 3 days.
• If the INR is 4.51-6, reduce the dose by 1 tablet with INR monitoring every other day.
• If the INR is greater than 6, warfarin is discontinued.

In general, anticoagulants are drugs with many pitfalls. The main ones are the risks of spontaneous bleeding (including hidden) and brain accidents that can lead to death. In this regard, anticoagulant drugs should be taken only as prescribed and under the supervision of a physician, taking into account all the circumstances of the disease, the risks of the patient and laboratory monitoring data, which should be thorough and regular.

New in the use of anticoagulants

Titration (gradual dose selection) of Warfarin for maintenance therapy goes through two stages: the actual dose selection and long-term treatment with maintenance doses. Today, all patients are divided into three groups depending on their sensitivity to the drug.

• Highly sensitive to Warfarin. They quickly (within a few days) from the start of taking the drug achieve therapeutic target INR values. Further attempts to increase the dose lead to a high risk of bleeding.
• Individuals with normal sensitivity achieve target INR values ​​on average after a week from the start of therapy.
• Patients with reduced sensitivity to Warfarin, even at high doses for two to three weeks, do not give an adequate INR response.

These features of the bioavailability of Warfarin in different patients may require more careful (frequent) laboratory monitoring of INR during the treatment period, linking patients to laboratories. The patient can maintain relative freedom of movement and life by purchasing a simple Coaguchek device, which works similarly to a glucometer using test strips. True, the price tag for the device itself is about rubles, and consumables(a set of test strips) will cost six to seven thousand.

Today, a new generation of anticoagulants, which successfully replace Warfarin in many situations (cardiology, prevention and treatment of deep vein thrombosis of the extremities, pulmonary embolism, in the treatment and prevention of strokes), allows us to get away from the problem of INR control.

We are talking about three main drugs: Rivaroxaban (Xarelto), Apixaban (Eliquis) and Dabigatran (Pradaxa).

The first two of them are now successfully replacing parenteral anticoagulants in combination with warfarin in low-risk situations of pulmonary embolism.

Rivaroxaban (tablets 10, 15, 20 mg)

It shows maximum low risk bleeding, is safer in this group of complications compared to the combination of Warfarin and Enoxaparin. The effect of therapy appears quickly; INR monitoring is not required. In the treatment of pulmonary embolism or deep vein thrombosis of the lower extremities, 15 mg of the drug is prescribed twice a day for 3 weeks. Then they switch to a maintenance dosage of 20 mg once a day for months.

Apixaban

In the same situation, Apixaban is given in doses of 10 mg twice a day for a week, followed by 5 mg twice a day for life. The drugs are promising in terms of outpatient treatment of low-risk pulmonary embolism, which is currently treated in an inpatient setting.

These drugs are contraindicated if:

• ongoing bleeding
• in pregnant women,
• end stages of renal failure,
• severe liver pathologies.

Dabigatran

It cannot replace parenteral anticoagulants and is prescribed after treatment with them at a dose of 150 mg twice a day (110 mg twice in people over 80 years of age or receiving verapamil). In the treatment of ischemic strokes, Apixaban is the safest, which is prescribed for minor strokes on days 3-5, on average on days 6 (after a brain CT scan), and for severe strokes after 12 days.

The use of these drugs in the prevention of pulmonary embolism in patients with hip and knee replacement is also interesting. On average, anticoagulant therapy should begin 1-4 hours after surgery.

• In the case of using Rivaroxaban, it is used for 35 days during surgery hip joint and 14 days for knee replacement.
• Dabigatran 35 and 10 days, respectively.

In cardiological practice, against the background of atrial fibrillation, stroke prevention can be carried out instead of Warfarin by any of these drugs. At the same time, Dabigatran (110 mg twice a day) and Apixaban (5 mg 2 times a day) are more effective than Warfarin and their use has a lower risk of bleeding. Both Dabigatran, Apixaban, and Rivaroxaban, compared with Warfarin in these situations, give lower statistics of complications such as hemorrhagic stroke. Rivaroxaban for the prevention of ischemic stroke against the background of atrial fibrillation in doses of 20 mg once a day has no advantages over Warfarin.

In the presence of mechanical prosthetic heart valves, as well as with mitral stenosis, switching from warfarin to new anticoagulants is impractical.

How to switch from one anticoagulant to another

The term new anticoagulants includes Rivoraxoban, Apixaban, Dabigatran.

• If it is necessary to switch from Warfarin to one of the new anticoagulants, Warfarin is discontinued and a period is maintained until the INR is less than 2. When this value is reached, one of the new anticoagulants is prescribed.
• If you need to replace a new anticoagulant with Warfarin, then it is simply added to the new anticoagulant until an INR of 2-3 is obtained. The INR should be monitored before the next dose of a new anticoagulant, with repeated monitoring one day after the last dose of the new anticoagulant.
• If a transition is made from parenteral forms of anticoagulants to new ones, then the first ones are immediately canceled, and a new one is given the next day.

How to compensate for incorrect reception

Often patients (especially older ones) make mistakes in the dosage regimen of the drug or simply forget whether they took it at all. To avoid extreme situations of bleeding or a sharp increase in the risk of thrombosis, there are certain rules correction of errors in taking new generation anticoagulants.

• If you miss taking a pill, then under no circumstances should you take a double dose. If the drug is usually taken twice a day (Pradaxa, Eliquis), the missed tablet can be taken within 6 hours after the missed time. For Xarelto, the same can be done within 12 hours. If this is not possible, the dose should be skipped and the next one taken as planned.
• If the patient accidentally took a double dose of a twice-daily drug (Pradaxa, Eliquis), then the next scheduled dose of the drug should be skipped. If a double dose was taken for Xarelto, there is no need to skip it, take the drug as usual.
• If the patient does not remember whether he took the tablet, then for Pradaxa and Eliquis additional dose not required next appointment The drug should be taken only 12 hours after the previous one. For Xarelto, you should take one tablet and consume the next one after 24 hours.

Bleeding problem

As with Warfarin, bleeding may develop with new anticoagulants varying degrees gravity. If bleeding is light, the anticoagulant will have to be discontinued. For moderate cases, additional drops of erythromass, platelet concentrate or fresh frozen plasma are added. Life-threatening bleeding requires prothrombin complex concentrate or surgical treatment.

There are no specific antidotes for warfarin (neither Vikasol nor Etamzilat are suitable).

Today, the antidote Idarucizumab is registered and used in Europe for Dabigatran. Its registration in the Russian Federation is planned for 2017. Most often the drug is used in emergency situations(for example, in case of life-threatening bleeding or emergency surgical care).

Preoperative preparation

All major surgical interventions require transferring the patient from warfarin or new anticoagulants to parenteral low molecular weight heparins.

However, minor surgery can be provided to the patient without changing anticoagulation therapy. In particular, patients may be treated on Warfarin or new anticoagulants:

• dentists (for removal of 1-3 teeth, installation of an implant, periodontal surgery, opening of abscesses oral cavity),
• ophthalmologists (cataract removal, glaucoma surgery).
• Diagnostic endoscopy does not require changing the anticoagulant.

The only detailed and specific article of all publications on anticoagulants, sincere thanks to everyone who worked on this material. Good health to you!

Thank you, the material was very useful.

Thanks for the detailed explanation useful information I’m not taking anticoagulants yet, but they’ve already been prescribed. The price is unaffordable for pensioners, this is a problem.

And if I take Cardiomagnyl, can I take Xarelto? And what is the difference between them?

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Blood clotting is a rather complex, multi-stage process in which enzymes play a major role. With a lack of specific protein, clotting indicators worsen. This may indicate the presence of pathology and deterioration in the functioning of the entire body. In order to first of all, it is necessary to undergo an examination and establish the cause of the disease. After this, the specialist will select optimal method treatment.

possible reasons

Specific proteins, fibrinogens, which are involved in the formation of fibrin blood clots, are responsible for normality. Various factors can affect the level of this substance. Experts call the following deviations the main reasons for this pathological condition:

• disturbances in the functioning of the liver (tumors, infectious pathologies);
• malfunction of the immune system;
• DIC syndrome (pathology of hemostasis);
• thrombophilia;
• iron deficiency anemia;
• thrombocytopenia;
• vitamin deficiency;
• hereditary predisposition;
• long-term use of drugs from the group of anticoagulants and angiogenesis inhibitors.

If a process such as blood clotting is disrupted, frequent nosebleeds and the causeless appearance of bruises on the body are observed. One of the symptoms is also gum bleeding. With the help of systemic and local drugs, blood clotting can be increased. Such medications should be prescribed by a doctor after diagnosis. IN mandatory the patient must pass laboratory tests and undergo an ultrasound examination of the liver to exclude the development of cirrhosis.

What to do if you have poor blood clotting?

Patients who have a history of such a diagnosis should know how to protect themselves from the development of various types of complications. Take any medications or try prescriptions traditional medicine on yourself is extremely undesirable. Only after finding out the reasons for the deviation and receiving doctor’s recommendations regarding treatment should you begin therapy.

Besides drug effects, attention must be paid to the power supply system. Eating certain foods will help improve blood clotting rates. Negative psycho-emotional state and disorder proper nutrition lead to changes in the production of fibrinogen protein.

Treatment with drugs

Depending on the etiology of the pathological condition, the specialist prescribes the patient certain drugs that increase blood clotting. Such medications include:

• coagulants - directly affect the production of fibrinogen (“Vikasol”, “Thrombin”);
• synthetic drugs that improve blood clotting (aminocaproic acid);
• agents that stimulate the formation of blood clots;
• preparations of animal origin (“Aprotinin”, “Pantripin”);
• drugs of synthetic origin that reduce the permeability of vascular walls (“Rutin”, “Androxon”);
• herbal preparations that reduce vascular permeability (nettle, arnica).

Before taking any medicine, you must carefully study the instructions and make sure there are no contraindications.

The drug "Vikasol"

Antihemorrhagic drugs that increase blood clotting can improve the production of prothrombin in the liver and enhance the production of hemocoagulation factors. A doctor should prescribe such medications, determining suitable dosage and duration of therapy for a particular patient.

The hemostatic drug "Vikasol" is a coagulant. indirect action and is prescribed to enhance blood clotting. This vitamin preparation, which is an analogue (synthetic, water-soluble) of vitamin K. The active ingredient in the composition is sodium menadione bisulfite (15 mg). The drug is available in the form of an injection solution and tablets.

Indications

The drug can be used as part of complex treatment with uterine bleeding, hemorrhagic disease(including in newborns), menorrhagia.

Indications for the use of Vikasol also include the following conditions:

• frequent nosebleeds;
• vitamin K hypovitaminosis;
• hepatitis;
• bleeding during surgery;
• cirrhosis.

To prevent bleeding, the medicine is prescribed for long-term treatment with anticoagulants and for pregnant women in the last trimester.

The drug "Rutin"

Medicines that increase blood clotting from the group of flavonoids have a therapeutic effect by reducing capillary fragility. One of these drugs is Rutin. The active substance - rutoside - replenishes the deficiency, strengthens the vascular walls, relieves inflammation and swelling. The drug is available in the form of tablets and powder, which contain 20 mg of rutoside.

The drug will be effective for various pathological conditions: hemorrhoids, lack of vitamin P, lymphostasis, superficial thrombophlebitis, chronic venous insufficiency, It is recommended to take “Rutin” three times a day, 20-50 mg at a time.

Contraindications and side effects

The drug should not be prescribed to pregnant women in the first trimester, as well as to patients with hypersensitivity to the components in the composition. Side effects in the form of headache, allergic skin reaction, heartburn, diarrhea, belching develop in rare cases.

Traditional medicine recipes

Prevent bleeding from injuries skin plants will help. Increase blood clotting medicinal herbs used for preparing decoctions, lotions and compresses.

Yarrow has the necessary property. The plant has positive influence on the condition of blood vessels, stops the inflammatory process, accelerates tissue regeneration. Dry grass (15 g) is poured warm water(200 ml) and boil for 15 minutes. After which the decoction should be infused, strained and taken 1 tbsp. spoon before meals three times a day.

For any bleeding, it is useful to take a decoction of nettles. To prepare it, you need to take 10 g of dry grass and pour a glass of boiling water. Steam the drink for 20 minutes, then filter and take a tablespoon 3 times a day.

Arnica will help increase blood clotting. The drug based on the flowers of the plant can be purchased in the form of drops or an infusion can be prepared at home. For a glass of boiling water (200 ml) you need to take 2 tbsp. spoons of dried flowers and steam for 40 minutes. Take 1 tbsp. spoon 2-3 times a day.

Diet

Experts recommend including foods that increase blood clotting in your diet. These include spinach, cabbage (regular and cauliflower), corn, carrots, red berries, bananas, walnuts. Eating buckwheat porridge, legumes, animal fats, white bread, and liver will be beneficial.

In order to increase blood clotting, these products should be present in the daily menu. The diet should be varied. Products Listed should only complement it. Diet food and traditional medicine recipes for problems with blood clotting will help people who have contraindications to drug therapy. This method of maintenance treatment is completely safe for children.

The complex enzymatic process of blood clotting determines normal functioning internal organs, natural cessation of bleeding and wound healing. The normal coagulation process requires the protein fibrinogen, which takes part in the formation of fibrin clots. Healthy body with a normal aggregate state of blood and lymphatic fluid, it independently copes with minor hemorrhages, forming blood clots, but reduced concentration fibrinogen leads to serious disorders. In a person with poor clotting blood, there may be internal bleeding, and bruises may appear on the skin even with minor exposure.

Medicines that increase blood clotting are prescribed exclusively by a specialist, but there are also folk methods, increasing the amount of fibrinogen in the blood. The clotting rate largely depends on what foods a person consumes and what bad habits he has.

Causes of bleeding disorders

The main reasons affecting the aggregate state of the blood are hidden in systemic disorders of the body.

• Reduced immunity, autoimmune diseases;
• Liver pathologies, infectious lesions;
• Impaired production of anticoagulants.

In an adult or child, a poor clotting rate is accompanied by the following symptoms:

• the appearance of hematomas on the body with minor exposure;
• scratches on the skin for a long time bleed;
• bleeding gums appear;
• When internal organs are injured, life-threatening internal bleeding develops.

Drugs that increase fibrinogen levels

Drugs from the hemostatic group, which can increase blood clotting and eliminate the disturbance in the production of anticoagulants, can relieve the symptoms of bleeding and act directly on the cause of the disease.

To the list of such medicines includes:

1. Drugs that increase the production of fibrinogen (directly affecting the causes of pathology) are coagulants. These drugs can be direct (Fibrinogen, Thrombin) or indirect (Vikasol).
2. Drugs of synthetic origin that improve coagulation - Aminocaproic acid, Amien or animal origin - Pantripin, Aprotinin.
3. Drugs that stimulate thrombus formation - calcium chloride, serotonin adipate.
4. Drugs that reduce permeability vascular wall. There are synthetic substances - Rutin, Adroxon and natural ones - arnica, yarrow, nettle.

Traditional methods

Natural substances will be useful for people with poor blood clotting, and they are safe for children and adults with contraindications to drug treatment.

1. Yarrow: indicated for poor clotting, affects the condition of blood vessels, eliminates inflammatory processes, promotes rapid tissue regeneration. From this plant you can prepare decoctions and infusions that will help in rapid recovery wounds, nosebleeds. The plant is poisonous, so it can only be used after consultation with a specialist;
2. Pine nut shells and extracts can be used to eliminate minor bleeding in the oral cavity or to regenerate superficial skin trauma.
3. Natural medicines that affect fibrinogen levels include corn, which needs to be supplemented in the diet, as well as in preparing decoctions.
4. Cope with heavy bleeding or a burn wound, an infusion of marsh dried herb will help. This natural plant It is also used in medicine, helping to cope with circulatory disorders. Dried marsh is used to prepare tinctures, decoctions and local compresses. A contraindication for use is increased blood pressure, purulent lesions skin and thrombophlebitis.

Diet

The diet with reduced coagulation does not change dramatically; it is enough to include in the diet some foods that affect the fibrinogen level and contain vitamin K.

Products that improve blood clotting:

Important! The daily menu should include products from this list, but the diet should be varied.

Poor, irregular nutrition, along with negative psychological factors, can provoke a disruption in the production of fibrinogen, which will cause pathology, so treatment should be accompanied by normalization mental state, elimination of stress factors and regular nutrition.

Violation of the aggregative state of the blood leads to a sign serious problems, therefore, when specific symptoms You should contact a hematologist for a blood test and comprehensive treatment.

Drugs that can slow down the functioning of the human blood clotting system are called anticoagulants.

Their action is determined by inhibition of the metabolism of those substances that are responsible for the production of thrombin and other components capable of forming a blood clot in the vessel.

They are used for many diseases, during which the risk of blood clot formation increases. venous system lower extremities, vascular system of the heart and lungs.

History of discovery

The history of anticoagulants began at the beginning of the twentieth century. In the fifties of the last century, a medicine capable of thinning the blood had already entered the world of medicine, with active substance coumarin.

The first patented anticoagulant was (WARFARIN) and it was intended exclusively for baiting rats, since the drug was considered extremely toxic to humans.

However, the increasing frequency unsuccessful attempts Warfarin suicides forced scientists to change their minds about its danger to humans.

So in 1955, Warfarin began to be prescribed to patients who had suffered a myocardial infarction. To this day, Warfarin ranks 11th among the most popular anticoagulants of our time.

Direct and indirect anticoagulants

NOA indirect action

New indirect anticoagulants affect vitamin K metabolism in one way or another.

All anticoagulants of this type are divided into two groups: monocoumarins and dicoumarins.

At one time, such drugs as Warfarin, Sincumar, Dicumarin, Neodicoumarin and others were developed and released.

Since then, no radically new substances have been developed that affect vitamin K levels.

Taking such drugs has a large number of contraindications and additional, often inconvenient, tests and diet compliance.

Anyone taking indirect anticoagulants must:

• calculate your daily intake of vitamin K;
• regularly monitor the INR;
• be able to change the level of hypocoagulation during intercurrent diseases;
• monitor for possible sudden appearance of symptoms of internal bleeding, in which case immediately consult a doctor and switch to another group of anticoagulants in the near future.

But anticoagulants are not strictly divided into direct and indirect-acting drugs. There are several groups of substances that have the properties of thinning the blood in one way or another. For example, enzyme anticoagulants, platelet aggregation inhibitors and others.

So a new one appeared on the market antiplatelet agent Brilinta. The active substance is ticagrelor. A representative of the class of cyclopentyltriazolopyrimidines, it is a reversible antagonist of the P2Y receptor.

Direct acting NOA

New indirect-acting anticoagulants include the following drugs.

Dabigatran

A new anticoagulant direct thrombin inhibitor. Dabigatran etexilate is a low molecular weight precursor active form dabigatran. The substance inhibits free thrombin, fibrin-binding thrombin and platelet aggregation.

Most often used for the prevention of venous thromboembolism, in particular, after joint replacement.

In pharmacies you can find a medicine with the active ingredient dabigatran - Pradaxa. Available in capsule form, containing 150 mg of dabigatran etexilate per capsule.

Rivaroxaban

Highly selective factor Xa inhibitor. Rivaroxaban is able to dose-dependently increase APTT and HepTest results. The bioavailability of the drug is about 100%. Does not require monitoring of blood parameters. The variation coefficient of individual variability is 30-40%.

One of prominent representatives a drug containing rivaroxaban is Xarelto. Available in 10 mg tablets active substance in each.

Apixaban

The drug can be prescribed to patients who are contraindicated to take vitamin K antagonists.

Compared to acetylsalicylic acid, it has a low risk of embolism. Apixaban selectively inhibits the coagulation factor FXa. It is mainly prescribed after planned knee or hip replacement.

Produced under the name Eliquis. Has an oral form.

Edoxaban

The drug belongs to the newest class of fast-acting factor Xa inhibitors. As a result clinical trials Edoxaban was found to have the same ability to prevent blood clots as Warfarin.

And at the same time, it has a significantly lower likelihood of bleeding.

Features of taking these drugs

Should use with caution in elderly patients, with a significant deviation in weight from the norm, with impaired renal function, and diseases associated with improper functioning of the circulatory system.

One of the features of many new anticoagulants is their speed of action and fast half-life. This suggests that you need to be extremely careful in following your pill-taking regimen. Since even missing one pill can lead to complications.

For bleeding that occurs as a result of therapy with certain anticoagulants, there is specific treatment.

For example, when bleeding due to Rivaroxaban, the patient is prescribed prothrombin concentrate or fresh frozen plasma. If blood loss occurs due to Dabigatran, hemodialysis, recombinant FVIIa, is performed.

Conclusions

The development of new anticoagulants continues to this day. Problems with side effects in the form of bleeding.

Even some new drugs require control.

The number of contraindications, although reduced, has not been completely eliminated. Some drugs still have slightly increased toxicity.

Therefore, scientists continue to search for a universal remedy with high bioavailability, lack of tolerance, absolute safety and intelligent regulation of the level of prothrombin in the blood, depending on other factors influencing it.

An important aspect is the presence of an antidote in the drug, if immediate surgery is necessary.

However, new drugs, in comparison with drugs of the last century, have very noticeable positive differences, which speaks of the titanic work of scientists.

IN medical practice Anticoagulant therapy is intended to prevent thrombosis and treat pathologies of the heart and vascular system. They produce medicines in the form of creams, gels, ointments, capsules, injection solutions, in tablets. It is strictly forbidden to select the dose yourself, as this can cause severe bleeding.

Impact

Thrombosis is a dangerous and common condition that often leads to heart attacks, strokes, heart attacks and fatal outcome. Disability in these conditions is inevitable. Therefore, doctors prescribe anticoagulant therapy to their patients with clotting problems in advance.

Thanks to early treatment It is possible to prevent the formation and expansion of blood clots, as well as blockage of blood vessels. Typically, anticoagulants act in a complex manner, affecting not only the blood clot itself, but also coagulation in general.

Anticoagulant therapy consists of suppressing plasma clotting factors and thrombin synthesis. It is due to thrombin that fibrin threads and thrombotic clots are formed.

Classification

Anticoagulant substances are classified into the following groups:

• pathological and physiological anticoagulants;
• indirect anticoagulants;
• direct anticoagulant components;
• new oral anticoagulants (NOACs);
• antiplatelet agents.

Modern anticoagulants, in turn, are divided into direct anticoagulants and indirect anticoagulants.

Pathological components

Formed in the blood during pathologies. These are strong immune coagulation inhibitors, which are specific antibodies that affect certain factors. As a rule, such antibodies are synthesized by the body in order to protect it from manifestations of blood clotting.

Physiological components

Normally found in the blood. They are usually distinguished into two types:

• secondary;
• primary.

This group includes the following list of substances:

• Heparin;
• Antithrombin III;
• Protein C;
• Complement inhibitor-I;
• Alpha2-macroglobulin;
• Protein S;
• Lipid and contact inhibitors;
• Antithromboplastins.

Heparin is a polysaccharide whose synthesis occurs in mast cells. Studies have shown large amounts of heparin in the liver and lungs. The use of large doses of the component suppresses platelets and leads to inhibition of blood clotting. As a result, bleeding from internal organs occurs. Therefore, it is important not to use heparin medications on your own without medical supervision.

Secondary physiological anticoagulants include the following list of drugs:

• Antithrombin I, IX;
• Antithromboplastins;
• PDF products;
• Fibrinopeptides;
• Metafactors Va, XIa.

Direct action

Direct anticoagulants reduce thrombin activity, deactivate prothrombin, inhibit thrombin and prevent the formation of new blood clots. When using direct anticoagulants, it is important to regularly monitor clotting parameters. This is necessary to prevent internal bleeding.

After using direct-acting agents, the therapeutic effect occurs immediately due to the rapid entry of substances into the body. Excretion is carried out by the kidneys.

This group of funds includes:

• Heparin - can suppress platelet aggregation, accelerating blood flow to the heart and kidneys. The drug leads to a decrease in blood pressure, a hypocholesterolemic effect, increased vascular permeability, and suppression of the proliferation of smooth muscle cells. The substance is indicated for intravenous administration when emergency conditions, as well as subcutaneously - for the prevention of thrombosis. Heparin is used externally for and. The substance is included in such drugs as Heparin ointment and Hepatrombin.
• Low molecular weight heparin – has high antithrombotic activity and is bioavailable. The effect of low molecular weight heparin is long-lasting, and the risk of developing hemorrhoidal complications is low. An important difference between this group of drugs is the minimal amount side effects. The injection is carried out subcutaneously in lateral surface belly. Low molecular weight heparins include: Fragmin, Klivarin, Clexane, Fraxiparin, Wessel Due F.
• Thrombin inhibitors. This group of medications includes: Hirudin, Girugen, Girulog, Lepirudin.

Indirect action

Indirect anticoagulants affect the biosynthesis of side enzymes of the coagulation system. However, they do not suppress the activity of thrombin, but completely destroy it. Another feature of these medications is their relaxing effect on smooth muscles. Due to this, the blood supply to the heart is stimulated.

Indirect anticoagulants are indicated for the treatment and prevention of thrombosis. Admission is carried out exclusively orally for a long time. If medications are stopped abruptly, prothrombin levels increase and the risk increases.

Indirect anticoagulants are divided into the following types:

• coumarin anticoagulants;
• Indan-1,3-dione derivatives.

Based on the classification, indirect anticoagulants, derivatives of coumarin and Indan-1,3-dione are as follows:

• Phenilin;
• Neodicoumarin;
• Warfarin;
• Acenocoumarol.

New anticoagulant substances

New anticoagulants are indicated for use in patients who need to take Varfanin for life. The fact is that Warfarin is an effective but unpredictable drug. For patients to whom it is prescribed, it is important to monitor their blood 7–10 times a day. If this is not done, the risk of bleeding increases significantly, which is ultimately difficult to stop.

The modern pharmaceutical industry is looking for ways to solve the problem of warfarin-dependent patients. For this purpose, new anticoagulants are used, which in medicine are referred to as oral anticoagulants.

Oral anticoagulants include:

• Xarelto (Rivaroxoban);
• Pradaxa (Dabegatran);
• Eliquis (Apixaban).

All these drugs are available in two dosage options. In this case, Rivaroxoban must be taken once a day. The rest are used twice a day.

Indications for the use of oral anticoagulants:

• atrial fibrillation;
• prevention of venous thrombosis;
• embolism prevention;
• ischemic stroke.

Advantages of oral anticoagulants:

• there is no need to calculate the dose;
• there is no need to regularly monitor the INR;
• Oral anticoagulant substances do not interact with food.

Flaws:

• must be taken regularly;
• a lot of research;
• risk of stomach bleeding;
• intolerance in some patients.

Indications and contraindications

Anticoagulant therapy is indicated for the following conditions:

• thrombotic and embolic stroke;
• rheumatic carditis;
• thrombophlebitis and acute thrombosis;
• the presence of atherosclerotic plaques;
• varicose veins and;
• aortic aneurysm;
• ischemic disease;
• TELA;
• DIC syndrome;
• atrial fibrillation.

It is important to note that not everyone is allowed to use anticoagulant drugs. Substances often prohibited from taking:

• patients suffering from bleeding hemorrhoids;
• patients with gastric and duodenal ulcers;
• persons suffering from renal or liver failure;
• with cavernous tuberculosis;
• patients suffering from vitamin C and K deficiency;
• patients with pancreatitis;
• persons suffering acute form leukemia;
• with alcoholism;
• patients suffering from Crohn's disease;
• with hemorrhagic retinopathy.

It is important to pay attention to the fact that anticoagulants are prohibited from being used during menstruation, during pregnancy and during pregnancy. breastfeeding. It is also prohibited for older people to take substances after childbirth.

Side effects

The phenomena identified in the reference books include the following list:

• nausea;
• vomit;
• skin rashes;
• osteoporosis;
• alopecia;
• possible complications in the form of bleeding from internal organs.

Antiplatelet agents

Prevent platelet aggregation and enhance the effectiveness of anticoagulants. Antiplatelet agents are able to dilate blood vessels and have an antispasmodic effect.

Antiplatelet agents include:

• Aspirin;
• Ticlopidine;
• Tirofiban;
• Dipyridamole.

Aspirin or Acetyl salicylic acid– bright representative of the group. The drug is available in various dosage forms. The substance is included in many products. Aspirin can inhibit platelet aggregation, provoke vasodilation and prevent the early formation of blood clots. Previously, Aspirin was widely used to reduce body temperature, but now the medicine is highly discouraged for this.

Anticoagulant substances are effective; they cannot be avoided in the treatment of pathologies of the cardiovascular system. However, it is important not to take them on your own, even the usual Aspirin. People who are used to “prescribing medications” to themselves often suffer from many side effects. It must be remembered that self-medication with anticoagulants can lead to irreversible and severe consequences in the form of severe bleeding.

Useful video about anticoagulants