Top 5 Blood Thinners

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

Let’s start with the fact that such a scientific term as “blood thinning” does not exist. There is an equivalent term – hemodilution, that is, dilution of blood with a liquid. It is used when the patient is severely dehydrated, such as suffering from severe, profuse diarrhea due to an acute intestinal infection. At the same time, the blood literally becomes very thick, it needs to be simply diluted, made more liquid, and its fluidity restored. This will require intravenous administration of a conventional isotonic solution, with a concentration of sodium chloride of 0,9%.

But those people who ask questions related to “blood thinning” in search engines, of course, are interested in something completely different and do not mean at all that they are being injected with isotonic solution intravenously. First of all, they are interested in the prevention of heart attack and stroke, and the way to avoid thrombosis. But in this case, we are not talking about “blood thinning” at all. In all normal people, and even those who experience heart attacks, strokes, and thrombotic processes, the blood has a normal density, or the so-called hematocrit. Hematocrit is the ratio of the liquid part of the blood, or plasma, to its thick part, or formed elements. Hematocrit is important in determining the degree of dehydration, or, more rarely, excess fluid in the body. Then what kind of medicines and blood condition are we talking about?

Antiplatelet agents and anticoagulants: what’s the difference?

We are talking about processes associated with excessive blood clotting, and not at all with the fact that it is thick. These are completely different mechanisms. Therefore, modern medicine has an extensive arsenal of drugs that prevent the severe consequences of excessive coagulation, thrombosis, and also prevent this very coagulation and thrombosis. And for this there are two large groups of drugs: antiplatelet agents and anticoagulants.

Let’s say right away that for those people who are interested in drugs for “blood thinning”, for example, for the purpose of prophylactic use, only drugs from the first group are suitable, that is, antiplatelet agents, they are also called antiplatelet agents. A typical representative of this group is Aspirin, or acetylsalicylic acid in low doses, clopidogrel.

What do anticoagulants do? This group of drugs prevents the formation of blood clots, stop the growth of already existing blood clots, and also enhance fibrinolysis, that is, dissolve an already formed blood clot. Disaggregants cannot do this. Classical representatives of anticoagulants can be considered heparin and warfarin. No one will take warfarin on their own, since it is prescribed to patients, for example, with artificial heart valves for therapeutic purposes. Artificial valves are a powerful thrombogenic factor. Therefore, it is necessary to constantly monitor that blood clots either do not form at all, or they quickly lyse, not having time to reach critical sizes.

As for heparin, it is also used for prevention, but in hospitals, after operations, in order to exclude pulmonary embolism and venous thrombosis. Usually, heparinization of the patient (when injections are given subcutaneously into the abdomen) is combined with tight bandaging of the legs, or wearing compression underwear. Obviously, the appointment of anticoagulants is a medical process, and the appointment of these serious drugs can be done only according to strict indications.

But antiplatelet agents can be bought without a prescription, as a prophylactic. Here are the quantitative data: anticoagulants are presented in pharmacies of the Russian Federation in the form of medicines of 74 trade names. But disaggregants – 137 different trade names. It follows from this that disaggregants are more profitable for manufacturers, and this is obvious: their market is more capacious.

What do antiplatelet agents, or antiplatelet agents, do? Their task is to prevent platelet aggregation.

What is platelet aggregation and why is it dangerous?

The main job of platelets is to participate in stopping bleeding, they form a primary, white blood clot. They also participate in the formation of the final, red, or fibrin thrombus. Platelets constantly circulate through the vessels of any caliber, from the aorta to the capillaries, and monitor if there is damage to the vascular wall somewhere or not. As long as there is no damage, platelets are not activated. As soon as a vessel injury occurs, platelets begin to show activity, and this is normal.

They adhere to the damaged wall and aggregate or stick together. This is how a platelet plug, or primary white blood clot, is formed. Also, activated platelets begin to produce biologically active substances, a whole cascade of reactions occurs, more and more platelets are involved in the process, the vessel wall contracts, blood coagulates and bleeding stops.

But, like any process, platelet aggregation can be disrupted. If this excess activation occurs without compromising the integrity of the vascular wall, then it can lead to the appearance of the same white blood clots unnecessarily, exacerbating atherosclerotic vascular damage. With the detachment of even a small thrombus from an atherosclerotic plaque, this cascade can be triggered, when platelets are “deceived” and begin to activate around the atherosclerotic thrombus or the place of its detachment.

Therefore, the task of antiplatelet agents should be considered to prevent the ability of platelets to stick together and stick to the inner lining of the vessel, or endothelium. Antiplatelet agents have another positive effect: they reduce the surface tension on the membranes of red blood cells, or erythrocytes. They become more durable, their deformation when passing through narrow capillaries does not destroy them, and the fluidity of the blood improves. A good, high-quality antiplatelet agent not only prevents erythrocytes from sticking together, but also destroys aggregated platelets that have already stuck together. When are antiplatelet agents used?

General indications for the appointment of antiplatelet agents

Unlike anticoagulants, which lyse blood clots and work already with the consequences of thrombosis, antiplatelet agents are mainly a means for prevention. They are prescribed as a means of preventing postoperative thrombosis, with various thrombophlebitis due to varicose veins, with chronic cerebral ischemia and atherosclerosis. But, of course, their main task is to prevent vascular accidents, that is, heart attack, stroke in coronary heart disease and atherosclerotic lesions of the carotid arteries.

Modern pharmaceuticals has a large number of drugs and even entire groups that, in addition to antiplatelet agents, also affect platelet aggregation. These are calcium blockers, and antihistamines, and organic nitrates. However, one of the most popular and effective drugs is the first representative of the group of non-steroidal anti-inflammatory drugs (NSAIDs), or acetylsalicylic acid (ASA). It is with her that we will begin a short list of drugs, since without acetylsalicylic acid there is nowhere to go, talking about antiplatelet agents. On the other hand, this group also includes drugs that are not intended for prevention, but exclusively for treatment, and are means “not for everyone”. Some of these tools will be discussed below.

Rating of the best blood thinners

A brief overview of antiplatelet agents

This list of medicines for the so-called “blood thinning”, or antiplatelet agents, includes 5 drugs, some of which are well-known, and few people know about them. First, the international non-proprietary name, or INN, is given in the drug list. Then – a list of trade names, and usually the first name is the original drug product, which appeared earlier than others, is the “flagship” for all commercial copies, or generics.

The original drug costs more than its commercial counterparts, but has the best reputation. The original drug has the most research, it is the best studied, including its effectiveness and safety, and therefore its higher price is justified. On the other hand, manufacturers of some generics, who have relied on extreme cheapness, may use substances of poor quality and dubious production. Also, for medicines, the average cost will be given, relevant for May 2020 for pharmacies of all forms of ownership in the territory of the Russian Federation.

The criteria for inclusion in this short list are the National Clinical Guidelines for the management of patients, protocols for the treatment of coronary artery disease, acute myocardial infarction, and other official literature. Advertising purposes were not pursued.

ASK (Aspirin-Cardio, Thrombo-ASS, CardiASK, Trombopol)

Rating: 4.9

The undisputed leader in terms of sales among all antiplatelet agents will be acetylsalicylic acid (ASA) in any form. This is usually low-dose aspirin, 75mg to 100mg, maybe a little more. A dosage of 50 mg is also sold for convenience, but it has been proven that only a dosage of 75 mg and above begins to have antiaggregatory properties.

Any ASA is an inexpensive drug, and Aspirin Cardio from the German company Bayer can be considered an example of one of the best and highest quality. Dosage – 100 mg, in a package of 28 tablets, designed for a month of admission, enteric tablets. This package will cost from 120 to 140 rubles. It is considered quite expensive. For example, we can cite the domestic Acecardol. these are also enteric tablets, in the same dosage, but they will cost here almost 30 rubles.

How does ASC work? It irreversibly inhibits one of the enzymes, type 1 cyclooxygenase, blockade of thromboxane synthesis occurs, and this process inhibits platelet aggregation. It goes without saying that Aspirin has both the usual anti-inflammatory and antipyretic effects, but for this the dose must be at least 5 times greater, that is, 500 mg.

When and who should take ASA as an antiplatelet agent? These may be people with risk factors for cardiovascular disease. For example, these are patients with overweight, obesity, physical inactivity, smokers, high cholesterol, and arterial hypertension. In this case, age does not really matter, but, as a rule, these are men, starting from 40 years of age. The indication will be unstable and stable angina pectoris, the risk of stroke, that is, transient disorders of cerebral circulation.

Aspirin is also prescribed as a remedy after a heart attack has occurred as a secondary prevention drug, after vascular surgery, for example, coronary artery bypass grafting, as a means for the prevention of thromboembolism, deep venous thrombosis.

For prophylactic purposes, it is advisable to use ASA half an hour before meals, once a day. The medicine is intended for long-term treatment, the duration of the course is determined by the doctor. The average dosage is 100 mg per day, a large dosage must be agreed with the doctor, for example, a month after a heart attack, it should be 200-300 mg per day.

Advantages and disadvantages

One should not think that ASA is a harmless remedy. It is categorically contraindicated in bronchial asthma, which is combined with nasal polyposis and intolerance to acetylsalicylic acid. It is strictly forbidden to take ASA to children, up to the age of 18, because of the possibility of developing a serious complication – Reye’s syndrome. Acetylsalicylic acid can cause ulcerative bleeding from a stomach ulcer, exacerbate erosive-ulcerative gastritis.

This medicine is prohibited with low blood clotting, with bleeding, severe disorders of the liver, kidneys, and heart failure. There are many conditions where ASA should be taken with caution, such as gout, high uric acid, or transient liver dysfunction. If we are talking about a pregnant woman, then you should definitely consult a doctor, since Aspirin can increase bleeding time, and lead to excessive blood loss during childbirth.

There are also side effects. These are increased bleeding, hematomas, nosebleeds, bronchospasm, abdominal pain, exacerbation of gastric ulcer. There is also an impressive list of drugs that can enhance the effect of ASA, and which enhances the use of ASA. Therefore, if the patient is taking any other means, then before prescribing aspirin for “blood thinning”, a doctor’s consultation is necessary. It is especially indicated that care must be taken if Aspirin is used together with anticoagulants.

In general, the official instructions for the seemingly “innocent aspirin” take up several pages, but this is due to the fact that this remedy has been known to medicine for almost a hundred years and has been well studied. But if you use acetylsalicylic acid strictly according to indications, taking into account all the facts set out in the official instructions, then it has been proven to reduce the risk of developing cardiovascular accidents, and can save many lives.

Clopidogrel (Plavix, Zylt, Lopirel, Egitromb)

Rating: 4.8

The next drug that can be considered the modern benchmark for antiplatelet blood thinners is clopidogrel, and Plavix was the first to enter the market. Plavix (Sanofi, France) is the original clopidogrel. After the release of Plavix, various analogues began to be created. However, even the cheapest domestic clopidogrel is several times more expensive than the most expensive imported Aspirin. Aspirin Cardio costs no more than 140 rubles. in May 2020. The cheapest domestic analogues of Plavix, which are produced by Akrikhin and Canonpharma Production, will cost 350-400 rubles for the same monthly course. How much will the original Plavix cost? For 28 tablets of 75 mg each, you will have to pay from 820 to 950 rubles in a pharmacy.

Why is clopidogrel better than ASA? The mechanism of action of clopidogrel is associated with the formation of an active metabolite, which occurs already in the body after the work of the cytochrome p450 system. Thus, the mechanism of action of clopidogrel is completely different. It affects other platelet receptors, and they are no longer capable of aggregation, and throughout their entire life. As you know, platelets live for about 7-10 days. The restoration of normal platelet function depends on the rate of their renewal.

We should not forget that a single dose of Plavix will block all platelets, but in just a few seconds, the red bone marrow will throw out a portion of new cells, which will also need to be blocked. Therefore, the drug must be taken daily. The effective dose is 75 mg, and if you take the medicine constantly, then after about 7 days its maximum effect occurs. If you stop taking it, then platelet aggregation will return to its original level after about 5 days.

Clopidogrel is more effective than ASA. It significantly reduces the incidence of stroke, heart attack, thromboembolism, more than Aspirin. It is also possible to combine clopidogrel with aspirin, and this is one of the best combinations, but it is necessary to carry out joint treatment with various antiplatelet agents under medical supervision.

The optimal indications for the use of clopidogrel are secondary conditions. It is prescribed to patients who have already had a heart attack, with acute coronary syndrome, with unstable angina. It is prescribed for acute myocardial infarction with ST segment elevation on the electrocardiogram. Importantly, clopidogrel works on endpoints that assess the risk of death from recurrent myocardial infarction or stroke. You need to take this medicine one tablet at a dose of 75 mg 1 time per day. Other dosages are also possible, for example, the first dose for acute coronary syndrome may be 300 mg. Long-term treatment with clopidogrel.

Advantages and disadvantages

Plavix is ​​contraindicated in severe hepatic insufficiency, in pregnant and lactating women, under the age of eighteen, as well as in acute bleeding, for example, from a stomach ulcer or other localizations. There are many conditions when it should be used with caution. For example, this is a joint reception with anticoagulants, antidepressants from the SSRI group, and so on. The safety profile of clopidogrel is somewhat better than that of aspirin. Against the background of admission, various dyspepsia, abdominal pain or diarrhea may occur, and these are the most common side effects.

Clopidogrel can also interact with other drugs: weaken or enhance their effect, and drugs, in turn, affect clopidogrel, so it must be prescribed by a doctor. In case of an overdose of clopidogrel, bleeding may occur, therefore, before treating the patient, it is necessary to carefully examine him and completely exclude all bleeding, including hidden ones. Therefore, only his own attending physician, who is well aware that there is no bleeding, can immediately prescribe clopidogrel to the patient. But in all respects, clopidogrel is superior to aspirin, and in combination with it in special doses, it best protects the heart and blood vessels, and significantly reduces mortality.

Xanthine nicotinate (Complamin)

Rating: 4.8

The next drug, perhaps, will be an alternative to the previous one. Xanthinol nicotinate is known to everyone, since this drug was prescribed back in the USSR. This is a cheap, folk medicine. After all, 60 tablets of 150 mg will cost no more than 200 rubles. In addition to tablets, the drug is available in dragee, in ampoules for injection and infusion. In addition to the antiaggregatory effect, which manifests itself moderately, the drug dilates blood vessels, and it was previously believed that it prevents the progression of atherosclerosis.

But with the introduction of evidence-based medicine methods into practice, a large number of randomized trials found that there is no difference whether the patient takes Xanthinol nicotinate or does not take it. This does not affect the level of “bad” cholesterol in any way, if we are talking about long enough time periods, and also does not affect the end points: namely, life expectancy.

Therefore, there are only 2 indisputable effects left: this is the expansion of peripheral vessels and the improvement of microcirculation, which means the supply of tissues with oxygen and nutrition. The drug activates fibrinolysis, that is, it also has some effects characteristic of anticoagulants. It improves blood viscosity and also inhibits platelet aggregation. Xanthinol nicotinate is indicated for various diseases associated with impaired microcirculation. These are Raynaud’s disease and syndrome, obliteration of the arteries, damage to blood vessels in diabetes, a condition associated with vascular thrombosis and embolism, which is sclerosis of the coronary vessels and transient cerebrovascular accident. Xanthinol nicotinate is also prescribed for trophic ulcers of the lower extremities, and hard-to-heal wounds. It is necessary to take medicines inside from 500 mg to 1 g 2-3 times a day, usually after meals. The duration of the course of treatment is determined by the doctor.

Advantages and disadvantages

The drug is contraindicated in a variety of bleeding and the threat of bleeding, with acute myocardial infarction, severe heart failure, as well as peptic ulcer of the stomach and duodenum in the acute stage. Of the side effects, perhaps the most unpleasant is the classic fever, “hot flashes”, redness of the skin of the upper half of the body and especially the neck, dizziness, diarrhea, and a transient increase in transaminases and uric acid in the blood.

But in the event that it is necessary that the antiaggregatory effect be combined with an improvement in blood circulation in the periphery, then, perhaps, except for Xanthinol nicotinate, no one can cope with this: neither ASA nor clopidogrel. Also, an additional advantage will be the low cost of the drug, and the possibility of using it in injections.

Calcium dobesilate (Doxy-Hem, Doxy-Lek)

Rating: 4.7

Doxy-chem is a medicine from Slovenia, produced by Hemofarm. It is not very expensive. For a package of 30 capsules of 500 mg, you can pay from 220 to 340 rubles. What is interesting about calcium dobesilate? First of all, the fact that this is a drug that, in addition to its antiaggregatory effect on platelets and a decrease in blood viscosity, also improves the quality of the vascular wall, therefore, they are classified as angioprotectors. This is especially true of small-caliber vessels, namely capillaries. Also, calcium dobesilate improves elasticity, and, consequently, the drainage function of the lymphatic vessels.

The action of the drug is associated with an effect on the kallikrein-kinin system of the blood plasma. Testimony is related to this. First of all, it is not used for the prevention of heart attack and stroke, but is prescribed to patients whose vessels have excessive fragility and permeability. This is the pathology of the retina in diabetes mellitus, nephropathy, as well as various microangiopathy, metabolic and cardiovascular genesis. A lot of calcium dobesilate is prescribed by vascular surgeons, phlebologists, with chronic venous insufficiency of the lower extremities and varicose veins, with trophic ulcers, superficial phlebitis and pain syndrome.

The drug is prescribed at 500 mg three times a day for two weeks, and then the dose is reduced to one capsule daily. The course of treatment can last from 3 weeks to several months, depending on the effect. In the case of diabetic retinopathy, the drug is prescribed for 4-6 months.

Advantages and disadvantages

The drug is well tolerated, but strict contraindications must be taken into account. These are hemorrhagic syndrome, bleeding from the gastrointestinal tract, exacerbation of gastric and duodenal ulcers, as well as pregnancy, especially in the first trimester and children under 13 years of age. Side effects are also possible, of which dyspepsia can be the most common. Doxy-Hem can also be prescribed prophylactically, to improve the plasticity of the vascular wall, and it is very good in the complex therapy of vascular disorders.

Ticagrelor (Brilinta)

Rating: 4.7

Finally, we present the most expensive antiplatelet drug available, or blood thinners. It’s ticagrelor, or Brilinta. It is produced by the well-known company Astrazeneca, 60 mg tablets in the amount of 56 pieces. Such a package will cost, depending on the pharmacy chain, in May 2020 from 2600 to 3100 rubles. What is this drug and why is it so expensive?

In principle, ticagrelor also reacts with platelets through adenosine diphosphate, so it is a bit like clopidogrel. But besides this, the drug has an additional mechanism of action associated with an increase in the concentration of adenosine. Adenosine is formed only in places of reduced oxygen supply, or hypoxia. Brilinta “prolongs the life” of adenosine, enhances its response, marking hypoxic areas. As a result, a vasodilating, cardioprotective and antiplatelet effect is additionally realized.

If the patient took clopidogrel at a standard dosage of 75 mg once a day, and then switched to Brilinta at a dosage of 90 mg 2 times a day, this led to an increase in the antiaggregation effect. Moreover, an increase by a quarter, that is, by 26%. If the patient does the opposite and starts taking clopidogrel instead of Brilinta, then this worsens the therapeutic effect by the same 25%. From this it follows that Brilinta is 25% more active than clopidogrel, this is a very good indicator, and therefore the drug is so expensive.

This medicine is shown in a rather narrow range: this remedy is not for everyone who wants a “blood thinner” remedy. This is the prevention of thrombosis in adults with a myocardial infarction 1 year ago or more, and in the presence of a high risk of thrombosis, for example, with an unfavorable lipid spectrum, which does not normalize when statins are present in the therapeutic regimen. Brilinta is taken orally, regardless of the meal. The recommended dose in patients with a history of myocardial infarction is 60 mg twice daily. Brilint treatment can be started a year after a heart attack. However, you can take this medicine at a dose of 2 mg 90 times a day, during an acute condition, and reduce the dose after a year.

Advantages and disadvantages

Despite the fact that Brilinta is 25% more effective than clopidogrel, there are contraindications. And these are, first of all, various types of bleeding, active bleeding, severe liver dysfunction, as well as taking medications that suppress the enzymes involved in the work of the drug. These are ketoconazole, clarithromycin, ritonavir. Do not prescribe medicine to children up to the age of eighteen. From the side effects studied on almost 40000 patients, it turned out that there was a very common increase in uric acid in the blood and shortness of breath. Further, dizziness, a decrease in blood pressure, and subcutaneous or intradermal hemorrhages were observed.

But given the need for active antiplatelet therapy in patients with a previous heart attack as a secondary prevention, this agent allows it to be carried out in the most intensive way, surpassing the most active “pure” antiplatelet agents listed in the list in its antiaggregatory power: acetylsalicylic acid, and even clopidogrel.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.