Anticoagulants – Effective but Troublesome

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Anticoagulants allow you to avoid thrombosis or stroke, but they are difficult to use properly – said Dr. Jarosław Woroń from the Jagiellonian University during the conference Anticoagulants – effectiveness and safety of use.

The Wednesday conference was organized at the Warsaw Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, as part of the nationwide Safe Drug campaign.

Thanks to the complicated clotting system, consisting of many elements, we can avoid both bleeding due to minor trauma and blood clots causing stroke, infarction or limb ischemia. However, when this balance is disturbed – after heart valve implantation, in conditions such as thrombosis, heart defects or atrial fibrillation – anticoagulants (anticoagulants) must be used.

As Dr. Woroń said, in such cases, if there are no contraindications, the appropriate drug is selected and systematically administered to the patient. The most commonly used are oral anticoagulants – warfarin and acenocoumarol, which are vitamin K antagonists. They start and stop working only after some time, and in addition, their action is influenced by many factors. Therefore, the treating physician must periodically perform a laboratory coagulation test – standardized prothrombin time (INR).

However, the patient’s safety largely depends on the patient himself – noted Dr. Woroń. Patients should avoid taking vitamin K, vitamin E, coenzyme Q10 and preparations containing them. The effect of anticoagulants may also be interfered by herbs and spices – sage, fenugreek, chamomile, anise, arnica, dandelion, horse chestnut, St. John’s wort, papaya extract, ginseng, ginkgo. Celery, parsley, garlic, onions, broccoli, cabbage and Brussels sprouts, cauliflower, turnips, cress, lettuce, spinach and avocado, as well as grapefruit and cranberry juices are dangerous. Among dietary supplements – glucosamine, melatonin, dehydroepiandrosterone (DHEA) and omega-3 acids.

In addition, anti-inflammatory and analgesic drugs are not recommended – such as aspirin, especially paracetamol, heartburn medications – omeprazole, ranitidine or famotidine – because they may interfere with the action of anticoagulants. Flu vaccination can also be risky.

The scientist added that the action of anticoagulants can also be disturbed by ordinary fever and heart failure, as well as diseases of the thyroid gland and liver. In the case of hypertension, it must first be lowered to the correct value in order to be able to administer anticoagulants – otherwise there will be dangerous microdamages of blood vessels.

Anticoagulation treatment is not recommended in the case of gastrointestinal bleeding, cancer, heart attack, diabetes – noted Dr. Woroń.

Unwanted symptoms of anticoagulants are – bleeding, even from the gastrointestinal tract (it is worth checking if the stool is black – it may be a symptom of stomach bleeding), nausea and vomiting, diarrhea, liver disorders and priapism – a painful, persistent penis erection.

The doctor also reminded that new generation anticoagulants, easier to take, such as dabigatran and rivarioxaban, have recently been available in Poland. However, they are not cheap – emphasized Dr. Woroń. (PAP)

What should patients taking anticoagulants take into account?

1. Take blood clotting drugs only in the dose prescribed by your doctor.
2. If you have not taken your medication at the specified time, do not add up the missed doses.
3. Remember to control your INR and make sure you know what your INR is during treatment.
4. Keep your head, abdomen, and chest safe, in particular.
5. Before taking a new medication, consult your doctor beforehand. Be careful with antibiotics, pain medications, and aspirin. Taking paracetamol is allowed, but only when necessary.
6. Always eat the same or similar amounts of meat, vegetables and fruit to avoid abrupt changes in your INR level.
7. If you are planning to become pregnant, please inform your doctor.
8. When any bleeding occurs, consult your doctor immediately.
9. Always have information with you that you are taking anticoagulant drugs – keep the document with this information in your purse, wallet, backpack, etc. Patients using such drugs also wear special bracelets.
10. Limit or quit drinking alcohol, and at least for the duration of your treatment – alcohol increases the effect of anticoagulants.

What are the indications for the use of anticoagulants?

Anticoagulants should be taken by people with thrombophilia, which is a genetically determined or acquired predisposition to develop venous thromboembolism. The clotting system of a person with thrombophilia is more likely to form clots. Many cases of the disease occur in people including with a congenital increase in the concentration of coagulation factors and cofactors.

The indication for the use of drugs is the antiphospholipid syndrome. It is an autoimmune disease caused by an abnormal immune system response. The cause of the disease may be a genetic predisposition, the use of contraception or hormone replacement therapy. Moreover, smokers are also exposed to it, but the etiology of the disease has still not been fully described.

Anticoagulants are also used to prevent ischemic stroke during cardiac surgery, e.g. insertion of artificial heart valves. Drugs that inhibit blood clotting are often administered to people after many surgical procedures, people with cancer and during the broadly understood prophylaxis of pulmonary embolism and deep vein thrombosis.

There is a group of patients for whom secondary thromboprophylaxis is recommended for the rest of their lives. These are mainly people with thrombin deficiency, patients with a homozygous form of factor V Leiden and people with the aforementioned antiphospholipid syndrome. Prophylaxis is also used in patients who have two causes of thrombophilia at the same time – they may even be two different causes.