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It is enough to drink grapefruit juice, and the anti-stroke medication can change its effect. Anticoagulants save lives, but if not taken properly, they can cause internal bleeding or lose their effectiveness.
The mechanism of blood clotting is complicated and depends on many factors. Thanks to him, we do not bleed to death when injured. However, its inadequate functioning causes the formation of blood clots causing stroke, infarction or limb ischemia. A disturbed clotting process can therefore kill or cause disability. Fortunately, there are effective medications to prevent excessive blood clotting. The problem, however, is that improper use may not work.
Anticoagulants – warfarin, acenocoumarol
Anticoagulants are called anticoagulants. – The most commonly used are oral anticoagulants – warfarin and acenocoumarol – explains Dr. Jarosław Woroń from the Department of Clinical Pharmacology of the Jagiellonian University. The intake of these drugs must be monitored by a doctor, which means that he should check the patient’s blood. In order to select the appropriate dose of the drug, it is necessary to check the blood clotting time frequently and modify its amount. Too low dose – this is a lack of protection against stroke, too high a risk of bleeding, because the blood will stop clotting as a result of the excess of the medicinal substance. These drugs must be taken regularly. Failure to be systematic can lead to ineffectiveness, with the risk of death if you are at risk of stroke. Besides, they only start and stop working after some time. In addition, their operation is influenced by a multitude of factors, and knowledge among patients on this subject is small.
Anticoagulants and diet
When treated with these drugs, even a slight change in the composition of the food can significantly affect their effectiveness. For example, all green vegetables containing vitamin K – parsley, watercress, broccoli, Brussels sprouts, lettuce, spinach, peas and cabbage interfere with their action. Celery, grapefruit, cranberry, garlic, onion, avocado, chard and cauliflower also change the effects of these preparations. Herbs and spices can also interfere with the therapeutic effect – sage, fenugreek, chamomile, anise, arnica, dandelion, horse chestnut, and St. John’s wort. Therefore, the sick person must avoid all these foods.
Anticoagulant – interactions with other drugs
Patients taking anticoagulants should not take vitamins K, E and coenzyme Q10. Multivitamin preparations are dangerous, as they may contain prohibited substances. Also, dietary supplements containing papaya extract, ginseng, ginkgo biloba, melatonin or omega-3 acids may interfere with the effects of anticoagulants. In addition, anti-inflammatory and analgesic drugs – such as aspirin, especially paracetamol, heartburn drugs – omeprazole, ranitidine or famotidine – are a problem. The patient must beware of them. Also, vaccinating against the flu while taking anticoagulant medications can be risky and you should inform your doctor before doing so.
Anticoagulants – contraindications
Dr. Jarosław Woroń emphasizes that bleeding after oral coagulants is one of the most common drug-induced side effects in elderly patients. Woroń warns that the effects of anticoagulants can be changed by ordinary fever, but also by heart failure, thyroid and liver diseases. In the case of hypertension, first you need to choose drugs that lower it so that the correct value is obtained. – Otherwise, there will be dangerous microdamages of blood vessels – says Dr. Woroń. Anticoagulation treatment is not recommended in the case of gastrointestinal bleeding, cancer, heart attack, diabetes, he adds.
dabigatran
New drugs have already appeared on the market that do not require continuous blood tests and clotting time determination. They have the same effectiveness, but – what is important – they are safer because they do not cause bleeding. In addition, they are less prone to interactions with other medications, supplements, and diet. One of them, dabigatran, was found to be more effective than warfarin in patients with atrial fibrillation and at risk of stroke. Only in patients with prosthetic heart valves or significant valve disease, severe renal insufficiency, or advanced hepatic insufficiency, warfarin may be preferable.
Text: Halina Pilonis
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