What are anticoagulants, list of drugs

Various vascular diseases lead to the formation of blood clots. This leads to very dangerous consequences, since, for example, a heart attack or stroke can form. To thin the blood, the doctor may prescribe medications that help reduce blood coagulation. They are called anticoagulants and are used to prevent blood clots from forming in the body. They help block the formation of fibrin. Most often they are used in situations when blood clotting is increased in the body.

It can arise due to problems such as:

  • Varicose veins or phlebitis,
  • Blood clots of the inferior vena cava,
  • Blood clots hemorrhoidal veins,
  • Stroke,
  • Myocardial infarction
  • Arterial injury in the presence of atherosclerosis,
  • Thromboembolism,
  • Shock, trauma or sepsis can also lead to blood clots.

Anticoagulants are also used to improve blood coagulation. If you used Aspirin before, now doctors have left this technique, because there are much more effective drugs.

Action of anticoagulants

Anticoagulants affect various parts of the blood coagulation process. There are direct-acting anticoagulants (heparin, hirudin, etc.) that lower blood thrombin activity, and indirect-action anticoagulants (dicumarin, warfarin, neodicumarin, or pelentan, phenylin, syncumar, etc.), which disrupt the formation of prothrombin in the liver, which is involved in coagulation blood.

Description

Anticoagulants mainly inhibit the appearance of fibrin filaments, they prevent thrombus formation, help to stop the growth of blood clots that have already arisen, and increase the effect of endogenous fibrinolytic enzymes on blood clots.

Anticoagulants are divided into 2 groups: a) direct anticoagulants - fast acting (heparin sodium, calcium nadroparin, enoxaparin sodium, etc.), effective in vitro and in vivo , b) indirect antacoagulants (vitamin K antagonists) - long-acting (warfarin, phenindione, acenocoumarol, etc.), they act only in vivo and after a latent period.

The anticoagulant effect of heparin is associated with a direct effect on the blood coagulation system due to the formation of complexes with many hemocoagulation factors and is manifested in the inhibition of coagulation phases I, II and III. Heparin itself is activated only in the presence of antithrombin III.

Indirect anticoagulants - derivatives of oxycoumarin, indandion, competitively inhibit vitamin K reductase, inhibiting the activation of the latter in the body and stop the synthesis of K-vitamin-dependent plasma hemostasis factors - II, VII, IX, X.

What are anticoagulants, principle of operation

Anticoagulants are called medications that perform the function of thinning the plasma. They help prevent the formation of thrombotic nodes, minimize the occurrence of a heart attack, stroke, as well as the formation of venous and arterial blockages.

It is worth noting that previously formed blood clots do not undergo resorption with the help of such drugs.

The drugs are well tolerated, support the health of people who have artificial heart valves or have an uneven heartbeat. If the patient has suffered a heart attack or has other heart diseases (cardiomyopathy), anticoagulants are also prescribed.

The action of such funds is aimed at reducing the ability of blood to coagulate (clotting), namely, under their influence, the likelihood of clots that can block the passage of vascular joints is reduced. As a result of treatment, the risk of a heart attack or stroke is minimized.

Anticoagulants (what it is, the peculiarity of their use are described below) are divided into groups:

  • physiological - constantly produced by the body and enter the bloodstream,
  • pathological - when detected in the plasma, they can show the presence of any pathology.

The first group is divided into:

  • primary (their synthesis occurs constantly),
  • secondary (produced after the splitting of blood flow factors by dissolving fibrin in it).

Classification and mechanism of action

The division is carried out according to the nature of the effect, pharmacological activity and the ways in which the medication affects the patient's body.

The classification of anticoagulants is rather scarce, there are two main types: direct and indirect action. But they more than cover therapeutic needs in all clinical cases.

Direct and indirect anticoagulants

Distinguish between direct and indirect anticoagulants. The former quickly thin the blood and are eliminated from the body within a few hours. The second accumulate gradually, providing a therapeutic effect in a prolonged form.

Since these drugs reduce blood coagulation, you can not lower or increase the dosage yourself, as well as reduce the time of admission. Medicines are used according to the schedule prescribed by the doctor.

Primary natural preparations

This group of pharmaceuticals is divided into:

  • inhibitorsformed due to the self-reproduction of fibrin,
  • antithrombin - the main factor of plasma protein,
  • antithromboplastins - factor of the plasma anticoagulation system.

If the patient has a predisposition to reduce these substances, then it is likely that he may develop thrombosis.

Group of natural primary drugs:

NameFeatures of Origin
HeparinHas a class of polysaccharides, its synthesis occurs in mast cells. Its large volume falls on the liver and lungs. An increase in the concentration of this substance inhibits platelet function, which prevents the development of blockage of the veins.
Protein CIt is produced by the liver cells, has an inactive state in the blood. To activate it, thrombin is needed.
Antithrombin IIIIt is produced in the liver and belongs to alpha2 glycoproteins. Reduces blood clotting activity, while not affecting inactive anticoagulants.
Protein SFormed by the liver.

The use of anticoagulants

Anticoagulants are used for myocardial infarction and lung, thrombotic and embolic strokes, thrombophlebitis and others, prophylactically - for atherosclerosis of the coronary arteries, cerebral vessels, rheumatic mitral heart defects, in surgery - to prevent the formation of blood clots in the postoperative period, during hemodialysis - for use with automatic plasmapheresis devices for harvesting human blood components (red blood cells, platelets, plasma).

Indications for use

Anticoagulants are used not only for the successful prevention of thromboembolism, this appointment is suitable for increased thrombin activity and the potential threat of blood clots that are dangerous for systemic blood flow in the vascular walls. The platelet concentration is gradually reduced, the blood acquires an acceptable flow rate, the disease recedes. The list of drugs approved for use is extensive, and their specialists prescribe for:

  • atherosclerosis,
  • liver diseases
  • vein thrombosis,
  • vascular disease
  • thrombosis of the inferior vena cava,
  • thromboembolism,
  • blood clots of hemorrhoidal veins,
  • phlebite
  • injuries of various etiologies,
  • varicose veins.

Direct-acting anticoagulants

Anticoagulant drugs of this group are created mainly for emergency situations. Under the influence of direct-acting anticoagulants, the pathological process is stopped, blood clots are lysed, after which the drugs are metabolized and excreted. The effect is short-term, but also enough for the occurrence of heavy bleeding with an improperly selected dose of the drug. The self-prescribing of anticoagulants is like death.

Indirect

This subgroup of pharmaceuticals has a complex mechanism of action due to the capabilities of the active components that make up the drug.

The useful result is fundamentally different from that of the previous group of medicines.

Indirect anticoagulants affect thrombin, completely neutralizing the compound, destroying it. In addition, they act on other coagulation factors, indirectly affecting the rate of aggregation of shaped blood cells.

In addition to the liquefying effect itself, medications of this type contribute to the normalization of the nutrition of myocardial tissues, relax the muscles of the vessels, also remove organic salts, and restore the concentration of cholesterol.

Due to the relatively lower aggressiveness in use, these medicines can be used in long courses.

Side effects are also severe and the risks of their development with uncontrolled use are great. It is unacceptable to take this subgroup on your own.

It is impossible to speak unequivocally about which medicines are better. It all depends on the specific clinical case.

Secondary physiological drugs

The preparations of the group include the following active substances in the formula:

  1. Antithrombin I.
  2. Antithrombin IX.
  3. Meta-Factors XIa and Va.
  4. Febrinopeptides.
  5. Auto-2 anticoagulant.
  6. Antithromboplastins.
  7. PDF (substances that arise when fibrin is dissolved).

Indications for admission

Direct anticoagulants are used with constant monitoring of complications in the treatment of a number of diseases with high blood coagulation:

  • acute venous thrombosis: hemorrhoids, varicose veins, phlebitis, postoperative complications (valve transplantation, prolonged lying position), obstruction of the inferior vena cava, postpartum thromboembolism,
  • acute arterial thrombosis: angina attack, AMI (acute myocardial infarction), ischemic stroke (acute cerebrovascular accident), pulmonary embolism, acute heart failure, parietal thrombus in the region of the heart,
  • acute injuries of the arteries of the lower extremities against the background of atherosclerosis, inflammation, rupture of the aneurysm,
  • disseminated intravascular coagulation syndrome against the background of sepsis, shock, injuries,
  • autoimmune pathologies: lupus erythematosus, rheumatoid arthritis, scleroderma, dermatomyositis, juvenile arthritis,
  • any microcirculatory disorders.

Indirect anticoagulants

Indirect anticoagulants are so named because they affect the formation of prothrombin in the liver, and do not affect coagulation itself immediately. This process is lengthy, but the effect due to this is prolonged.

They are divided into 3 groups:

  • Monocoumarins. These include: Warfarin, Sinkumar, Mrakumar,
  • Dicumarins are Dicumarin and Tromexan,
  • Indandions are Phenylin, Omefin, Dipaxin.

Most often, doctors prescribe warfarin. These drugs are prescribed in two cases: with atrial fibrillation and artificial heart valves.

Often patients ask what is the difference between Aspirin cardio and Warfarin, and is it possible to replace one drug with another?

Experts say that Aspirin cardio is prescribed if the risk of stroke is not high.

Warfarin is much more effective than Aspirin, besides it is better to take it for several months, or even throughout life.

Aspirin corrodes the gastric mucosa and is more toxic to the liver.

Indirect anticoagulants reduce the production of substances that affect coagulation, they also reduce the production of prothrombin in the liver and are antagonists of vitamin K.

Indirect anticoagulants include vitamin K antagonists:

Vitamin K is involved in the process of blood coagulation, and under the influence of Warfarin, its functions are impaired. It helps to prevent blood clots and vascular obstruction. This drug is often prescribed after a myocardial infarction.

There are direct and selective thrombin inhibitors:

Direct:

Selective:

Any direct and indirect anticoagulants are prescribed only by a doctor, otherwise there is a high risk of bleeding. Indirect anticoagulants accumulate gradually in the body.

Apply them only orally. It is impossible to stop treatment immediately, it is necessary to gradually reduce the dose of the drug. Abrupt drug withdrawal can cause thrombosis. With an overdose of this group, bleeding may begin.

Pathological preparations

With the development of serious diseases in the bloodstream, immune-type inhibitors are formed that act as specific antibodies. Such bodies are intended to prevent coagulation.

These include inhibitors of factor VII, IX. During the course of autoimmune diseases, a pathological type of protein appears in the bloodstream. They have antimicrobial properties and an inhibitory effect on coagulation factors (II, V, Xa).

List of drugs

Heparin for local use is a classic form of medication. It is prescribed for hematomas, in the initial stages of varicose veins.

The concentration of the active ingredient is minimal, therefore, the likelihood of side effects with proper use is negligible.

List of direct-acting anticoagulants: Heparin, Lyoton, Venolife, Hepatrombin, Heparin ointment. Partially, the component is present in Troxevasin ointment.

Means for internal use. They are used to treat systemic diseases when it is impossible to limit oneself to local exposure.

This includes two subtypes of drugs:

  • The first are low molecular weight heparins. The list of product names: Clexane, Klivarin, Fragmin, Fraxiparin, Gemapaksan, Troparin. They provide a quick effect and relatively powerful, affect other coagulation factors in addition to thrombin, to a lesser extent. They are used according to indications, as emergency drugs or for the treatment of chronic diseases.
  • The second is medium molecular weight heparins. The common name is Cybernine.

The list of anticoagulant preparations is much wider, however, the key ones presented on the pharmaceutical market are precisely based on the named substance.

Local heparins

One of the most popular foundations of classic external anticoagulants is heparin. The substance interacts with plasma proteins, vascular endothelium, macrophages. Heparin-based drugs do not fully guarantee protection against thrombosis: if the thrombus has already appeared and is located on an atherosclerotic plaque, then heparin cannot act on it.

Used to solve thrombosis problems locally:

  • Heparin ointment - heparin in the composition relieves inflammation, tissue pastiness, dissolves old blood clots, prevents the formation of new ones, other components dilate blood vessels, which improves the absorption of the ointment, anesthetize (35 rubles),
  • Venolife - balances blood microcirculation, demonstrates angioprotective, phlebotonizing effect (400 rubles),
  • Lyoton-gel - reduces thrombin activity, platelet aggregation, increases renal blood flow, has a lipid-lowering effect (322 rubles),
  • Venitan - an anticoagulant with venoprotective properties (250 rubles),
  • Lavenum - a direct-acting anticoagulant drug for external use, which is part of the group of medium molecular heparins, has an antithrombotic, anti-exudative, moderately anti-inflammatory effect (180 rubles),
  • Trombless - has anti-inflammatory, antiproliferative, decongestant and analgesic effects (250 rubles),
  • Heparin-Akrikhin - has a decongestant, moderate anti-inflammatory effect, with external use it prevents the formation of blood clots (215 rubles),
  • Hepatrombin - in addition to thrombo-absorbing properties, the drug has a regenerating effect (120 rubles),
  • Hepatrombin G - the presence of a hormonal supplement (prednisone) enhances the anti-inflammatory effect (165 rubles),
  • Heparoid Zentiva - a representative of anticoagulants with a pronounced local analgesic effect (175 rubles),
  • Troxevasin - a combination of venotonic, phleboprotective and anticoagulant (170 rubles)
  • Troxerutin Vramed - flavonoid with P-vitamin activity, angioprotector (38 rubles).

Antiplatelet agents

Medications reduce the synthesis of thromboxane and are intended to prevent stroke and heart attack, which can occur from the formation of glued blood clots.

Aspirin is the most common and affordable antiplatelet agent. Often, patients who have survived an attack are prescribed aspirin. It blocks the formation of condensed blood masses in the coronary arteries. After consultation with a medical specialist, it is possible to use this drug in small dosages (for prevention).

Patients who have had a stroke and heart valve replacement are prescribed ADP (inhibitors of adenosine diphosphate receptors). This drug is injected into a vein, and prevents the formation of clots that can clog vessels.

Thrombosis drugs:

Like any other medications, antiplatelet agents have a number of side effects:

  • permanent fatigue
  • frequent heartburn
  • headache,
  • nausea,
  • abdominal pain
  • a sharp change in stool,
  • blood flow from the nose.

With such manifestations, the patient must consult a medical specialist to reassign the drugs.

Also, there are side effects in which it is necessary to completely stop taking medications:

  1. Allergic reactions (swelling of the face, larynx, tongue, limbs, lips, rash).
  2. Vomiting especially with the presence of blood clots.
  3. The chair is dark in color or bloody.
  4. The presence of blood in the urine.
  5. Difficult inhale and exhale.
  6. Unrelated speech.
  7. Signs of arrhythmia.
  8. Yellowness, acting on the skin and on the eye proteins.
  9. Sore joints.
  10. Hallucinations.

For some patients, antiplatelet agents are prescribed by a doctor for life, so they systematically need to take blood to check its coagulability.

PLA anticoagulants

This is a new generation of oral and parenteral anticoagulants, the development of which modern scientists are engaged in. Among the advantages of this purpose, a quick effect, complete safety on the risk of bleeding, and reversible inhibition of thrombin are distinguished. However, there are drawbacks of such oral anticoagulants, and here is their list: bleeding in the digestive tract, the presence of side effects and contraindications. In addition, to ensure a long therapeutic effect, thrombin inhibitors must be taken for a long time without violating the recommended daily doses.

The drugs are universal, but the action in the affected body is more selective, temporary, requires long-term use. In order to normalize blood coagulation without serious complications, it is recommended to take one of the claimed list of new generation oral anticoagulants:

Contraindications

Typical grounds for refusal to use:

  • Bleeding of any localization. Do not pass the amplification process, which ultimately will become fatal for the patient.
  • Proven coagulation disorders. In various diseases, whether it is thrombocytopathy, a disorder in the production of special substances involved in the aggregation of shaped cells.

  • Hemorrhagic stroke. Accompanied by the destruction of the vessel in the brain. With the parallel use of direct anticoagulants, a large hematoma that compresses nerve tissue develops. This is the path to death.

  • Aneurysms. Wall protrusion of arteries.

  • Malignant hypertension. Stable rapid increase in pressure to critical levels.
  • Pathology of the gastrointestinal tract. Especially ulcerous, potentially capable of provoking bleeding.
  • Recently performed operations. Any localization.
  • Individual intolerance to the components of the drugs. Allergic reactions.

The list is not complete. Evaluation of the list in the annotation for a specific name is required.

Heparins intravenous and subcutaneous administration

The mechanism of action of drugs is a combination of inhibition of coagulation factors in blood plasma and tissues. On the one hand, anticoagulants block thrombin, which inhibits the formation of fibrin. On the other hand, they reduce the activity of coagulation factors of blood plasma and kallikrein.

Heparins destroy fibrin and inhibit platelet adhesion. They are injected into a vein or subcutaneously, are not interchangeable (you can not change drugs during the course). Distinguish between low and medium molecular weight heparins.

Low molecular weight drugs have little effect on thrombin, inhibiting the Ha factor of the blood coagulation system, which improves their tolerance. The drugs have high bioavailability, antithrombotic action, completely stop all pathological coagulation factors. Direct low molecular weight anticoagulants have their own list of the most effective drugs:

  • Fraxiparin (calcium nadroparin) - 380 rubles / syringe,
  • Gemapaksan (Enoxaparin sodium) - 1000 rubles / 6 pieces,
  • Clexane, Anfibra, Enixum (Enoxaparin sodium) - 350 rubles / syringe,
  • Fragmin (Dalteparin sodium) - 1300 rubles / 10 pieces of 2500 IU or 1800/10 pieces of 5000 IU,
  • Klivarin (Reviparin sodium) - 198 rubles / syringe,
  • Troparin (Heparin sodium) - 237 rubles / syringe,
  • Wessel Douai F - 2 834 rubles.

Medium molecular heparins include: Heparin, Heparin Ferein (Cybernine) - 500 rubles for 5 ampoules. The mechanism of action is similar to the classic low molecular weight heparins.

For thrombosis (thromboembolism), it is better to use Klivarin, Troparin. Thrombolytic complications (AMI, pulmonary embolism, unstable angina, deep venous thrombosis) are treated with Fraxiparin, Fragmin, Kleksan. For the prevention of thrombosis during hemodialysis, Fraxiparin and Fragmin are used.

Next-generation oral drugs

Anticoagulants (what it is and the principle of the effect of funds on the body is described in the article) are indispensable for many diseases. According to statistical indicators, most of them have a number of limitations and side effects. But manufacturers eliminate all the negative aspects, thanks to this they release all new and improved means of a new generation.

Any anticoagulants have both positive and negative sides. Scientists are conducting additional laboratory studies of drugs in order to further produce universal remedies for thrombosis and related diseases. The development of such drugs for young patients (children) and for those who have contraindications to their use are underway.

Pros of modern drugs:

  • minimized risk of spontaneous blood flow,
  • medicines function after 1.5 hours,
  • most people who have limited indications for warfine are already able to take new products,
  • Eating foods and other medicines do not affect the effectiveness of ANPs.

Disadvantages of PNP:

  • continuous testing of funds,
  • such funds should be drunk constantly, without gaps, since they have a short time period of action,
  • rarely, but there are undesirable effects associated with intolerance to the components.

The list of PUP contains a small amount of funds, since most of them are in the testing phase. One of the new products is Dabigatran, which is a low molecular weight drug (thrombin inhibitor). Medical specialists often prescribe it for venous blockages (for preventive purposes).

Another 2 PNPs that are easily tolerated by patients are Apixaban, Rivaroxaban. Their advantage is that there is no need to take blood at the risk of clotting disorders during treatment therapy. They do not respond to other drugs used, which is their plus. Stroke and attacks of arrhythmias are also well prevented by medications.

The price of anticoagulants

If it is necessary to reduce blood coagulation in the shortest possible time, doctors strictly recommend medications to take anticoagulants strictly for medical reasons - the list of drugs is extensive. The final choice depends on the pharmacological characteristics of that sludge drug, cost in pharmacies. Prices are different, and pay more attention to the therapeutic effect. Below you can find out more about the prices in Moscow, but do not forget the main criteria for such a purchase. So:

The name of the anticoagulant is from the list of drugs

Thrombin Inhibitors - Hirudins

Hirudin preparations representatives of direct anticoagulants have heparin-like action due to the inclusion of a medical leech in the protein composition from saliva, which blocks thrombin, completely eliminating it, inhibits the formation of fibrin.

Hirudins are preferred for patients with heart disease, as they have a prolonged effect. They are available for injection and in tablets, but the oral anticoagulants of this subgroup are completely new drugs, so little has been studied, there are no long-term follow-up results. It is necessary to take anticoagulants with hirudin only on the recommendation of a doctor and under strict laboratory control.

The list of hirudin-based anticoagulants is constantly expanding, but the basis is composed of several drugs:

  • Piyavit - 1090 rubles,
  • Fondaparinux (Arikstra) - 1 200 rubles,
  • Argatroban (Argatra, Novastan) - 30,027 rubles,
  • Rivaroxaban - 1000 rubles,
  • Lepirudin (Refludan, Bivalirudin, Angiox) - 118,402 rubles,
  • Melagatran (Exanta, Ximelagatran) - 464 rubles,
  • Dabigatran (Pradaxa, Etexilate) - 1667 rubles,

The new anticoagulant Ximelagatran encouraged doctors to prevent strokes, but was toxic to the liver with prolonged use. Warfarin (an indirect anticoagulant) is still a favorite in this direction.

Another direct anticoagulant - Sodium hydrocytart is used exclusively for the preservation of blood and its components.

Classification of anticoagulants: direct, indirect action

Anticoagulants (what it is and the principle of their action is considered in the article for informational purposes, therefore they are forbidden to self-medicate) is usually divided into 2 main subgroups.

They are:

  • direct action (have the ability to act directly on thrombin, minimizing its activity, thereby diluting blood flow),
  • indirect exposure (affect the synthesis of enzymes (by-products) that regulate blood coagulation).
Direct and indirect anticoagulants: list

Medications are well absorbed by the walls of the stomach and, with time, are excreted in the urine.

Direct
  • Heparins (low molecular weight).
  • Hirudin.
  • Sodium hydrocytrate.
  • Danaparodid.
  • Lepirudin.
  • Heparin.
Indirect
  • Indandions.
  • Monocoumarins.
  • Dicumarines.

Therapin Group

The main and most common representative of direct-acting drugs is Heparin. Its composition includes sulfated glycosaminoglycants, various in size. It has low bioavailability.

The drug interacts with a large number of other components produced by the body:

Treatment with this drug does not completely protect against thrombosis. If a blood clot has already appeared and is located on an atherosclerotic plaque, then heparin is not able to act on it.

Heparin group preparations (oral tablets and ointments for external use:

  1. Venolife.
  2. "Heparin" (injection).
  3. "Clevarine."
  4. "Heparin ointment."
  5. "Lyoton gel."
  6. Trombless.
  7. Dolabene.
  8. Xarelto.

Reviews

Marina, 29 years old. My blood coagulation has been impaired since childhood. She knew nothing about anticoagulants as a pharmacological group. The doctor advised taking an Aspirin tablet every morning. So I continue this procedure for several years. Since there are no health problems, I think that such a medicine works. Cheap and cheerful.

Alexandra, 37 years old From the list, I chose the medicine Rivaroxaban for myself. The medication is new, but effective - it provides effective prevention of thrombosis. In our family, such a disease along the female line is inherited, so I worried in advance about generally available preventive measures. The drug is inexpensive, no complaints.

Victoria, 32 years old. I have found varicose veins for several years now. The veins not only caused a strong inferiority complex, but also periodically hurt. The medicine Lyoton gel from the list of direct anticoagulants helped me. The medicine works quickly, additionally relieves increased fatigue of the extremities after a working day.

Valentina, 41 years old From the list of drugs I can praise Warfarin, which acts quickly and accurately on a health problem. I was diagnosed with a microstroke a year ago by a doctor, and for me it was completely unexpected - apparently, I had it on my legs. This medicine was immediately prescribed for quick rehabilitation. The drug helped, side effects did not occur, although they were threatened.

List of drugs

The list of indirect anticoagulants includes three items:

  • Warfarin. It is available in the form of tablets for oral administration and is prescribed to patients in most cases. Among others, it is considered the safest and most effective. An important plus can be called a significant dependence on the dosage. The higher the concentration in the blood, the more serious the positive effect.

In this case, as soon as the drug is canceled, negative phenomena, side effects quickly disappear. The versatility and flexibility of Warfarin make it indispensable in the treatment of most pathologies.

  • Neodicumarin. It is prescribed relatively rarely in acute cases. At the same time, the use of a medication requires systematic administration, because a positive effect does not appear immediately, but gradually, as the active component accumulates in the body.
  • Acenocoumarol. It is used as an effective analogue in case of intolerance to the previous name.

Indirect medicines are used strictly according to indications, despite the great safety and variability of the positive effect.

Side effects

There are several side effects of direct anticoagulants, but the following are most common:

  • internal bleeding
  • hematomas
  • dyspepsia,
  • migraine,
  • pallor of the skin
  • severe dizziness with headaches,
  • allergic rashes,
  • blood impurities in urine, feces, vomit,
  • prolonged nosebleeds
  • gum repair
  • change in menstruation in women (duration, profusion).

Oligopeptides

Anticoagulants (what it is and how they affect the body can be found below) from the group of oligopeptides affect the activity of thrombin. These are potent blood clot inhibitors. The active components of medicines are reunited with blood coagulation factors, changing the location of their atoms.

Some group drugs:

These funds are used to prevent:

  • heart attacks
  • varicose veins
  • thromboembolism,
  • reocclusion after plasty of the vascular walls.

What you need to know

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

Low molecular weight heparins

Low molecular weight heparins have an elevated bioavailable threshold and antithrombotic effect. In the process of their use, there is a risk of hemorrhoidal complications. The components of the drugs tend to be rapidly absorbed and excreted for a long time.

Medicines of this subgroup completely eliminate the factors contributing to abnormal coagulation of blood flow.

They increase the synthesis of thrombin and do not have a serious effect on the throughput of the vascular walls. The drugs help to improve the rheological properties of blood flow, and also positively affect the blood supply to all organs, leading to a stable state of their function.

Names of drugs of low molecular weight heparins:

TitleCharacteristic
FragminAvailable as a clear or slightly yellowish solution. The drug can not be administered intramuscularly. An agent is prescribed in increased doses for the field of surgical intervention, especially for those patients who have a risk of bleeding.
KlivarinDirect anticoagulant that affects blood coagulation. The medicine acts as a neutralizer of blood coagulation, is prescribed for thromboembolism (prevention, treatment).
ClexaneThe medicine against inflammation and antithrombotic. Before you start taking this drug, you must exclude from the use of all drugs that affect hemostasis.
"Fraxiparin"Liquid solution, antithrombotic and anticoagulant action. At the injection site, hematomas and compacted bumps may appear, after a few days they disappear on their own. If you take large doses of the drug at the beginning of treatment, then bleeding may develop, but after this effect disappears.
Wessel Douai FA drug with a natural composition is obtained from the intestinal mucosa of animals. The tool helps to suppress factors that affect blood coagulation. The components of the drug contribute to the synthesis of prostaglandins. They block the development of a previously formed thrombus and are prescribed to eliminate thrombus-forming processes.

Indications for appointment

Indirect anticoagulants are recommended in the following conditions:

  • CHF,
  • during the rehabilitation period after surgical interventions on the vessels and heart,
  • as the basis for the treatment of recurrent myocardial infarction,
  • TELA - pulmonary embolism,
  • atrial fibrillation,
  • left ventricular aneurysm,
  • thrombophlebitis
  • obliterating endarteritis, thromboangiitis.

The mechanism of action of anticoagulants

Anticoagulants affect various parts of the blood coagulation process. There are direct-acting anticoagulants (heparin, hirudin, etc.) that lower blood thrombin activity, and indirect-action anticoagulants (dicumarin, warfarin, neodicumarin, or pelentan, phenylin, syncumar, etc.), which disrupt the formation of prothrombin in the liver, which is involved in coagulation blood.
Thrombosis is a dangerous and common condition that often leads to heart attacks, strokes, heart attacks, and death. Disability in these conditions is inevitable. Therefore, doctors prescribe anticoagulant therapy to their patients with coagulation problems in advance.

Thanks to early treatment, it is possible to prevent the formation and increase of blood clots, as well as blockage of blood vessels. Usually, anticoagulants act in a complex manner, affecting not only the thrombus itself, but also on coagulation as a whole.

Anticoagulant therapy consists in suppressing plasma coagulation factors and thrombin synthesis. It is due to thrombin that fibrin filaments and thrombotic clots form.

With a slowdown in blood flow, congestion in the vessels, there is a risk of developing a blood clot. But in order for it to form, another factor is needed - endothelial damage. This mechanism leads to platelet adhesion to the vascular wall. This entails a physiological reaction of the circulatory system, which is expressed in layering on a clot of fibrin, the retention of red blood cells there.

The last step is the retraction of the thrombus, that is, the dense adhesion of all its parts to each other (as if gluing). Circulatory system diseases, in which blood is initially supposed to have a thick consistency, can contribute to these processes. In addition, there is a response of the body to large fluid loss - DIC, which is manifested by intravascular coagulation and is a common cause of death in patients.

The reaction inverse to blood thickening is its dilution. For this, the body has special substances that control this process - anticoagulants. Most often, with diseases of the vascular system, natural defense is not enough. Therefore, substitution therapy with medications containing anticoagulants is carried out.

The drugs are widely used in medicine, and are used both for emergency care for patients and for preventive purposes. These drugs exert their effect by impairing the formation of fibrin, one of the participants in thrombus formation. They can affect blood coagulation using direct and indirect mechanisms.

Hirudin preparations

The drugs of this group have some similarities with the heparin group, they also have an antithrombotic effect. They have in their composition a substance that is produced in the saliva of leeches - hirudin. It binds to thrombin and irreversibly eliminates it. Also, the drug partially affects other factors that affect blood coagulation.

Means based on hirudin:

All drugs are on sale not so long ago, so the experience of their use is small.

Natural blood thinners

Some products also have anticoagulant activity.

  1. Large volumes of liquid - water, compote, tea.
  2. Cucumbers
  3. Watermelon.
  4. Flaxseed oil and low-fat fish.
  5. Oatmeal
  6. Cranberry drinks from other dark berries.
  7. Iodine-containing products - seaweed.
  8. Grape drinks.

Unfortunately, the use of these products does not fully support the hemostatic system at an appropriate level.

However, such properties must be remembered by people who take anticoagulant drugs - an excess of their use can cause internal and external bleeding.

List of indirect anticoagulants: drug names

Anticoagulants (what it is described above in the article) of indirect action are characterized below in the table:

NamePropertyApplication
FenilinIt is rapidly absorbed into the bloodstream, easily passes the histohematological barrier and accumulates its effect in the tissues of the body. The drug is prescribed for the prevention of thrombosis and complications after surgery. After therapy, convulsive seizures of the legs and their numbness disappear in patients.Inside, according to a certain scheme, which the specialist will appoint.
NeodicumarinUnder the influence of the drug, along with a decrease in prothrombin, there is a decrease in proconvertin, a decrease in the rate of blood coagulation, and minimization of resistance to heparin.

The tool reduces the fat content in the bloodstream, increasing the permeability of the vascular walls.

Take the medicine inside under the supervision of specialists and with the control of prothrombin, and other indicators that affect blood coagulation.
WarfarinThe drug blocks the process of formation of vitamin K, on ​​which factors affecting blood coagulation depend. It minimizes their concentration in plasma, due to which, the process of clotting of blood flow slows down.The drug must be taken orally, once every 24 hours. Drink pills every day at the same time. The duration of therapy should be clarified by the medical specialist who prescribed this drug.

Anticoagulant Monitoring

In the case of the appointment of indirect anticoagulants, constant monitoring of blood coagulability through the INR system (international normalized ratio) is required. This is the control and quality assurance of the therapy. Such observation makes it possible to timely dose adjustment or drug withdrawal, helps to assess the risk of complications. INR is a derivative of prothrombin time, during which coagulation of biological fluid occurs.

In fact, INR is the correlation of the prothrombin time of a particular patient with the standard norm of blood coagulation. The INR indicator ranges from 0.85 to 1.25 units. Treatment with indirect coagulants (mainly Warfarin) involves the achievement of a stable level of 2-3 units.

  • the first time - before starting therapy,
  • the second - on the second or fifth day,
  • the third (final) - on the 10th day.

Further monitoring is carried out once a month (if necessary: ​​once every half a month). If the dose of an indirect anticoagulant is small (less than 2), add a tablet a week to a normal level. With high INR (more than 3), they also reduce the dose. With INR above 6, the indirect coagulant is canceled. Monitoring is mandatory because there is a high risk of spontaneous, uncontrolled bleeding with a fatal outcome.

List and review of direct-acting anticoagulants

Preparations (anticoagulants) of direct action:

  • "Heparin ointment", is on sale in a tube of 25g, its cost is from 50 rubles., The drug is produced by a Russian pharmaceutical company.
  • Heparin-Akrikhin, is available in the form of a gel for external application, the tube has a volume of 30 g, the manufacturer is Russia, and its cost is from 230 rubles.
  • Trombless, is produced by a Russian pharmaceutical company in the form of a gel for external application, the tube has a volume of 30 g, the cost of this drug varies from 250 to 300 rubles.
  • Venolife - gel for external application, is available in the form of a tube, the volume of which is 40 g, the cost of the drug is located at around 350 rubles.

As a treatment and for prevention, medical specialists prescribe such drugs as:

  • Clexane - injection (produced by a French pharmaceutical company). The drug blocks the blockage of blood vessels by thrombotic commissures, changes the composition of enzymes that are aimed at blood coagulation. The cost of the drug is 1,500 rubles.
  • "Fraxiparin" also produced by a french company. The active substance helps to thin the blood and reduces the risk of blood clots. This is an injectable drug, the cost of which is 2200 rubles.
  • Fragmin - An American-made injection is prescribed for people who have a risk of blood clots. The cost of the product is 2000 rubles.

Possible adverse reactions

Drugs can cause the following problem states in patients:

  • the presence of blood clots in the urine,
  • dark or black feces,
  • bloody smudges under the skin,
  • long nosebleeds
  • bleeding gums
  • provoking vomiting with streaks of blood or bloody expectoration,
  • in women, the nature and amount of menstrual blood (cycle length and number of secretions) may change.

Do I need a prescription from a doctor?

Since anticoagulants affect the coagulability of blood flow, bleeding may occur if this is not observed (usually it is internal hemorrhage). It is forbidden to engage in self-medication, it is necessary to consult a medical specialist, which will give detailed recommendations. From pharmacies, such drugs are dispensed without a prescription from a medical specialist.

Article design: Lozinsky Oleg

Anticoagulants - what are these drugs?

Seeing incomprehensible names in the recommendation sheet, patients want to quickly find out what anticoagulants are and what they are prescribed for. The term anticoagulants, the list of drugs in this group is extensive, it is customary to designate drugs that, acting on the human body, sharply inhibit the process of blood coagulation.

As a result of their action, doctors manage to prevent the formation of blood clots (blood clots). Medications are used to prevent complications in various situations. It is worth noting that doctors prescribe anticoagulants also for preventive purposes, in order to reduce the risk of thrombosis.

Anticoagulants - classification

The mechanism of action of anticoagulants is different, so they are usually divided into two large groups:

  1. Direct anticoagulants.
    These substances quickly act on the blood coagulation system by inhibiting the formation of fibrin. Medications of this group include medium and low molecular weight heparins, sodium hydrocytrate. The mechanism of action of standard heparin is associated with inhibition of thrombin activity and inactivation of hemostasis factors.
  2. Indirect anticoagulants
    - often they are called as antagonists of vitamin K. These drugs have a long-term effect. The effect of their use manifests itself over time, so they are often used for violations of the blood coagulation system. In their chemical structure, indirect anticoagulants can be derivatives of indandion or 4-hydroxycoumarin. The mechanism of their action is associated with inhibition of the synthesis in the liver of blood coagulation factors II (prothrombin), VII (proconvertin), IX (christmass factor) and X (stewart-praer factor).

Anticoagulants - indications and contraindications

Direct anticoagulants are used when there is an urgent need to normalize blood coagulation. For the prevention and treatment of thrombosis, doctors resort to indirect anticoagulants.

Antithrombotic therapy has a number of indications:

  • condition after surgery on the heart and blood vessels,
  • myocardial infarction
  • pulmonary embolism,
  • left ventricular aneurysm,
  • atrial fibrillation,
  • thrombophlebitis of superficial veins of limbs,
  • thromboangiitis obliterans, endarteritis.

Like any drugs, anticoagulants have a number of contraindications, they are not always used. The use of drugs of this group is prohibited for patients with the following disorders:

  • gastrointestinal tract diseases (gastric ulcer),
  • liver diseases (chronic hepatitis, cardiac fibrosis of the liver),
  • urolithiasis disease,
  • renal failure
  • thrombocytopenic purpura,
  • cavernous pulmonary tuberculosis.

Anticoagulants - side effects

Using oral anticoagulants, patients often face the development of side effects. Among the most common:

  • allergy,
  • headache,
  • asthenia,
  • fever
  • impaired renal function,
  • nausea, abdominal pain,
  • taste disturbance, vomiting,
  • diarrhea,
  • itching, rash on the skin.

Natural anticoagulants

Thanks to the process of blood coagulation, the body itself ensured that the thrombus does not go beyond the limits of the affected vessel. One milliliter of blood can contribute to coagulation of all fibrinogen in the body.

Due to its movement, the blood maintains a liquid state, as well as due to natural coagulants. Natural coagulants are produced in the tissues and then enter the bloodstream, where blood clotting is prevented.

These anticoagulants include:

  • Heparin
  • Antithrombin III,
  • Alpha-2 macroglobulin.

The best anticoagulants

Anticoagulant drugs are prescribed individually. In each case, the doctor determines the type of drug, dosage, frequency of administration and duration of administration, taking into account a number of factors:

  • type of pathology
  • patient age
  • contraindications
  • the presence of concomitant pathologies in the body.

Given the above characteristics of anticoagulant therapy, it is impossible to isolate the best from many drugs. Each case requires an individual approach, so only a doctor, based on the data of the studies, can determine what is best for the patient, which drugs are more appropriate to use.

Anticoagulants - tablets

When choosing a drug for treatment and prevention, doctors often pay attention to the form of release of the drug. The most convenient and affordable of the existing ones is tableted. You can take the pill at any time, for this there is no need for certain conditions and conditions, as in the case of injections. In most cases, indirect anticoagulants, vitamin K antagonists, are used in pill form.

Calling common anticoagulants, a list of drugs in tablets can be represented as follows.

Anticoagulants in ampoules - list of drugs

Blood thinners in ampoules are more often used in the development of emergency conditions. Pulmonary thromboembolism leads to a cessation of blood flow, which can be fatal. The introduction of anticoagulants directly into the bloodstream through intravenous injection allows you to quickly restore the patency of a blood vessel. For further prevention of relapse and treatment, infectious antithrombotic drugs can be added to solutions for drip administration.

Among antithrombotic drugs there are many anticoagulants produced in solutions, the list of drugs is long. Among the common ones, one can distinguish:

Antithrombotic creams and ointments

For local effects on the superficial blood vessels of the lower extremities, doctors prescribe antithrombotic agents in the form of ointments and creams. Similar drugs are often used for thrombophlebitis of leg veins, varicose veins (as a prophylaxis). Due to the physiological characteristics, these diseases are more common among the fair sex.

Only doctors can prescribe external antithrombotic drugs, the list of which is as follows:

  • Lyoton Gel,
  • Dolobene,
  • Heparin Akrigel 1000,
  • Trombless
  • Venitan N.

Blood coagulation system: the basics of physiology

Blood coagulation is a combination of physiological and biochemical processes aimed at stopping bleeding that has begun earlier. This is a protective reaction of the body, preventing massive blood loss.

Blood coagulation proceeds in 2 stages:

  • primary hemostasis
  • enzymatic coagulation.

Primary hemostasis

3 structures take part in this complex physiological process: the vascular wall, the central nervous system and platelets. When the vessel wall is damaged and bleeding begins, the smooth muscles located in it around the perforation site are compressed, and the vessels are spasmodic. The nature of this event is reflexive, that is, it occurs involuntarily, after the corresponding signal of the nervous system.

The next step is the adhesion (adhesion) of platelets to the site of damage to the vascular wall and their aggregation (gluing) together. After 2-3 minutes, the bleeding stops, since the site of damage is clogged by a blood clot. However, this blood clot is still loose, and the blood plasma at the site of damage is still liquid, so under certain conditions, bleeding can develop with renewed vigor. The essence of the next phase of primary hemostasis is that platelets undergo a series of metamorphoses, as a result of which 3 coagulation factors are released from them: their interaction leads to the appearance of thrombin and triggers a series of chemical reactions - enzymatic coagulation.

Enzymatic coagulation

When traces of thrombin appear in the area of ​​damage to the vessel wall, a cascade of reactions of interaction of tissue coagulation factors with blood starts, another factor appears - thromboplastin, which interacts with a particular substance prothrombin to form active thrombin. This reaction also occurs with the participation of calcium salts. Thrombin interacts with fibrinogen and fibrin is formed, which is an insoluble substance - its filaments precipitate.

The next stage is the compression, or retraction, of a blood clot, which is achieved by compaction, compression of it, as a result of which transparent, liquid blood serum is separated. And the last stage is the dissolution, or lysis, of a previously formed thrombus. During this process, many substances interact with each other, and the result is the appearance in the blood of the enzyme fibrinolysin, which destroys the filaments of fibrin and turns it into fibrinogen. It is worth noting that part of the substances involved in coagulation processes is formed in the liver with the direct participation of vitamin K: a deficiency of this vitamin leads to disruption of coagulation processes.

Features of the use of "Heparin"

The action of the substance is aimed at preventing the growth and spread of a blood clot. Heparin molecules form a complex with antithrombin, which is an inhibitor of coagulation factors. The substance is a chain of glycosaminoglycans. The drug is administered subcutaneously and begins its action after a couple of hours.

If necessary, rapid action "Heparin" is administered infusion intravenously in order to accelerate the effectiveness and increase bioavailability. The choice of dosage of the drug depends on the condition in which the patient is. In addition, the presence of concomitant diseases, the parallel administration of other groups of medicines, the need for surgical interventions on the vessels are taken into account.

Pathological anticoagulants

With the development of certain diseases in the plasma, powerful immune coagulation inhibitors sometimes accumulate, which are specific antibodies, for example, lupus anticoagulant. They indicate a particular factor. These antibodies can be produced to combat any manifestation of blood coagulation, but according to statistics, as a rule, these are inhibitors of factor VII, IX.

With the development of serious diseases in the bloodstream, immune-type inhibitors are formed that act as specific antibodies. Such bodies are intended to prevent coagulation.

These include inhibitors of factor VII, IX. During the course of autoimmune diseases, a pathological type of protein appears in the bloodstream. They have antimicrobial properties and an inhibitory effect on coagulation factors (II, V, Xa).

Cardiac Glycosides

Preparations based on raw materials of natural and synthetic origin, aimed at maintaining cardiac activity. Drug List:

  • "Cardiovalen." The product is based on natural extracts, sodium bromide and camphor. It is realized in the form of alcohol drops. It has a sedative effect. The dose is 15 drops before meals.
  • "Digoxin". Tablets with the same active substance. They have an inotropic and vasodilating effect with a moderate diuretic effect. Take "Digoxin" you need 4-5 times on the first day and 1-3 in the future.

Back to the table of contents

Potassium Channel Blockers

Belong to the 3rd class of antiarrhythmic medications, reduce myocardial excitability due to impaired impulse conduction. The drug "Amiodarone" normalizes the functioning of the heart with a practically constant cardiac output, improves coronary blood flow, slows the heartbeat and lowers blood pressure. It is used during powerful atrial fibrillation, the first two weeks you need to drink 3-4 tablets, then from half to 4 pieces, as maintenance.

Sodium channel blockers

Medicines that have a membrane stabilizing and antiarrhythmic effect. They are divided into 3 groups: A, B and C according to the force of impact. Among this group, “Propanorm” is effective. This antiarrhythmic drug is used for violations of the supra- and ventricular rhythm. It slows down the conduction of impulse along specific fibers, has a slight adrenergic blocking effect. Contraindicated in people with heart failure, not recommended for pregnant women, prohibited during lactation.

Metabolic drugs

An extensive heterogeneous group of drugs that changes metabolism in various variations. These drugs include “Panangin” - a preparation based on potassium and magnesium asparaginates, saturates the cells with ions of active substances. It is used to treat arrhythmias, mainly caused by electrolyte disturbances and atrial paroxysms. Contraindicated in chronic and acute renal failure and hyperkalemia.

Slow Calcium Channel Blockers

Inhibit the penetration of calcium ions into the muscles of the heart and blood vessels through specific channels. As a result, the coronary and peripheral arteries expand, that is, the expansion of blood vessels. These include Verapamil, which has a pronounced antianginal and antiarrhythmic effect, lowers blood pressure in the arteries. It has a large number of contraindications for concomitant diseases of the cardiovascular system.

Indandion preparations

After conducting a large number of studies, scientists have found that it is not worth using drugs based on this active substance in therapy. The drugs had a significant amount of side effects in the form of allergic reactions. The effectiveness of the impact on the anticoagulation system also did not show stable results.

This group of medicines includes drugs: “Fenindion”, “Diphenindion”, “Anisindion”. It was decided to stop the main choice on the second group of antiplatelet agents, and of the derivatives of indandion at the moment only “Phenylin” is used.

The drug has a low cost, is available in tablet forms. Valid for 10 hours, and it is very important to maintain the necessary duration of therapy. The effect occurs only 24 hours after the first dose. The use of funds occurs under the monitoring of the patient's condition using laboratory blood parameters (coagulogram, general tests, biochemistry).

Scheme of application of “Phenylin”:

  1. The first day - 1 tablet 4 times.
  2. The second day - 1 tablet 3 times.
  3. The rest of the therapy is 1 tablet per day.

The drug is not recommended to be taken simultaneously with drugs that reduce the level of glucose in the body.

When are medicines prescribed?

Before starting treatment it is very difficult to make a choice - the market offers a variety of drugs, from injections for intravenous infusion to oral anticoagulants. Despite the variety of forms, the indications for use with these drugs are the same. These include:

  • The presence of atherosclerotic plaques,
  • Thrombophlebitis of the veins
  • Acute and chronic thrombosis,
  • Hemorrhages of any etiology,
  • Various lesions of the membranes of the heart,
  • Mitral valve defects
  • Aortic lesion
  • Venous valve insufficiency and blood stasis,
  • Thromboembolism or blockage of blood vessels,
  • DIC
  • Heart rhythm disorders
  • Endarteritis and thromboangiitis obliterans.

The listed diseases directly or indirectly affect the blood, form complications in the form of increased coagulability and the formation of blood clots - this condition requires appropriate therapy. Anticoagulants are prescribed not only for treatment, but also for the prevention of blood diseases, as well as the cardiovascular system.

Despite the high efficiency, the drugs have some contraindications:

  • Ulcerative lesions of the upper digestive system,
  • Internal bleeding
  • Diseases of the pancreas, liver, kidney and heart,
  • Lack of vitamins
  • Inflammatory diseases of the lungs and heart,
  • Heart attacks and strokes,
  • Thrombocytopenic purpura,
  • Cerebrovascular aneurysm,
  • Hemorrhagic retinopathy,
  • Crohn's disease,
  • Various forms of leukemia,
  • Age over 65
  • The period of bearing a child and breastfeeding.

Pregnancy is an absolute contraindication to the appointment of these drugs, since any anticoagulant refers to agents that change the qualitative properties of the blood, which can affect the development of the fetus.

The list of main side effects from taking anticoagulants:

  • Allergic reaction,
  • Skin lesions
  • Digestive disorders
  • The gradual destruction of bone tissue,
  • Hair loss.

In most clinical cases, complications develop with an overdose - when the daily dose of the drug exceeds the maximum permissible, which leads to all kinds of disorders.

Direct-acting drugs based on heparin

This group of drugs has a direct effect on plasma cofactors that inhibit thrombin. The main representative is heparin. Based on it, there are a number of medicines that act similarly and have a consonant name:

Heparin or derivatives combine with antithrombin-III, which leads to a change in the location of its molecules. This accelerates the attachment of the cofactor to thrombin, and then to the inactivation of the coagulation process.

Impact

Anticoagulants affect various parts of the blood coagulation process. There are direct-acting anticoagulants (heparin, hirudin, etc.) that lower blood thrombin activity, and indirect-action anticoagulants (dicumarin, warfarin, neodicumarin, or pelentan, phenylin, syncumar, etc.), which disrupt the formation of prothrombin in the liver, which is involved in coagulation blood.

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

Thanks to early treatment, it is possible to prevent the formation and increase of blood clots, as well as blockage of blood vessels. Usually, anticoagulants act in a complex manner, affecting not only the thrombus itself, but also on coagulation as a whole.

Anticoagulant therapy consists in suppressing plasma coagulation factors and thrombin synthesis. It is due to thrombin that fibrin filaments and thrombotic clots form.

Warfarin: application features

Indirect anticoagulants (a list is in the article) are most often represented by Warfarin. This is a tablet product, available in 2.5, 3 or 5 mg. The effect on the human body develops after 1.5-3 days from the moment of the first pill intake. The maximum effect develops by the end of the first week.

After taking the drug, the rheological blood counts return to normal after 5 days from the day of. The tool is used 2 times a day at the same time.On the 5th day from the start of therapy, a blood test is performed to determine the feasibility and effectiveness of the application.

The course of treatment is selected by a specialist in each case individually. Some pathological conditions (for example, atrial fibrillation) require constant use. With the development of pulmonary embolism (pulmonary embolism), an antiplatelet agent is prescribed for at least six months or for life.

If necessary, surgery “Warfarin” must be canceled 5 days before the operation. This will allow blood counts to return to normal. If there is a high need to continue using anticoagulant therapy, this remedy is replaced by non-fractional heparin. The last dose is administered 4 hours before the intervention.

After surgery, after 4 hours, non-fractional heparin is reintroduced. Reception of indirect antiplatelet agents can be returned in two days, after monitoring the state of the blood using laboratory tests.

Help with overdose

The most common complication is poisoning, which can be caused by a violation of the dose of the drug or as a result of its use with alcohol.

In this situation, it is urgent to take the following measures:

  • Call an ambulance
  • Give the patient a lying position,
  • If the overdose is caused by taking the pills, rinse your stomach immediately by drinking plenty of water and induce artificial vomiting.

The doctor will examine the patient, if necessary, put a dropper with saline or vitamin K, which causes the opposite effect. If the patient's condition is serious, hospitalization and transfusion of blood plasma will be required.

Anticoagulants are excellent drugs used to treat most diseases of the blood and cardiovascular system. Medications can act directly, inhibiting platelet activity or indirectly through the liver. It should be carefully when during their use - observe the dosage, do not combine therapy with alcohol and do not carry out during pregnancy or during breastfeeding. If there are signs of poisoning, consult a doctor.

Various vascular diseases lead to the formation of blood clots. This leads to very dangerous consequences, since, for example, a heart attack or stroke can form. To thin the blood, the doctor may prescribe medications that help reduce blood coagulation. They are called anticoagulants and are used to prevent blood clots from forming in the body.


They help block the formation of fibrin. Most often they are used in situations when blood clotting is increased in the body.

Anticoagulants - List

In medical practice, doctors do not use both direct and indirect anticoagulants at the same time. The selection of the drug is carried out individually, taking into account many factors. More often, doctors use indirect anticoagulants (the list of drugs is presented below) as an excellent prophylactic for the treatment of thrombosis and thromboembolism, disorders of the blood coagulation system.

New anticoagulants

Previously, doctors used Warfarin exclusively for prolonged antithrombotic therapy. This medicine has been actively used in the treatment of non-valve atrial fibrillation, systemic embolism, pulmonary embolism. In such cases, patients had to constantly maintain the concentration of the drug in the bloodstream. For control, special home coagulometers were actively used. To facilitate the fate of such patients, pharmacologists have developed new-generation blood thinners.

Among the main advantages of these medicines are:

  • lack of need to monitor the hypocoagulant effect,
  • Short half-life
  • predictability of the pharmacological effect.

Existing new anticoagulants (the list of drugs is indicated below) is usually divided into two groups:

  1. Direct thrombin inhibitors (dabigatran).
  2. Direct factor Xa inhibitors (Rivaroxaban, Apixaban, Edoxaban).

Coumarin derivatives

Coumarin is a substance that is found in plants and can be synthetically produced under laboratory conditions. At first, after its removal, the drug was used as a poison for fighting rodents. Only after the passage of time did the drug begin to be used to combat excessive thrombosis.

Indirect anticoagulants - coumarin-based drugs - are represented by the following medications:

  • "Warfarin" (its analogues are "Marevan", "Warfarin sodium", "Warfarex").
  • "Acenocumarol" (analogue - "Sincumar").
  • "Neodicumarin" (analogue - "Ethylbiscum acetate").

Primary Natural Anticoagulants

They are usually divided into groups:

  1. Antithromboplastins.
  2. Antithrombin.
  3. Inhibitors of the fibrin self-assembly process.

With a decrease in the level of primary physiological anticoagulants in the blood, there is a risk of thrombosis.

This group of substances includes:

  • Heparin. It is a polysaccharide synthesized in mast cells. Significant amounts are found in the lungs and liver. In large doses, it interferes with the blood coagulation process at all stages, inhibits a number of platelet functions.
  • Antithrombin III. It is synthesized in the liver, refers to alpha-glycoproteins. Reduces the activity of thrombin and some activated coagulation factors, but does not affect inactive factors. Anticoagulant plasma activity is 75% provided by antithrombin III.
  • Protein C. It is synthesized by the cells of the liver parenchyma and is inactive in the blood. It is reduced to thrombin activity.
  • Protein S. It is synthesized by endothelial cells and liver parenchyma (hepatocytes), depending on vitamin K.
  • Alpha-macroglobulin.
  • Antithromboplastins.
  • Contact inhibitor.
  • Lipid inhibitor.
  • Complement inhibitor-I.

Secondary physiological anticoagulants

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

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

What are anticoagulants, which of them are classified as direct and indirect drugs

To avoid the occurrence of blood clots as dangerous blood clots, in the classification of drugs there is a pharmacological group called anticoagulants - a list of drugs is presented in any medical reference book. Such medicines provide control of blood viscosity, prevent a number of pathological processes, and successfully treat certain diseases of the hematopoietic system. In order for the recovery to be final, the first step is to identify and remove the coagulation factors.

Watch the video: Haemostasis 3 - Anticoagulants & Thrombolytics (February 2020).