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Anticoagulant

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What is Anticoagulant?

Anticoagulants decrease blood clotting. They do not dissolve existing blood clots, but help prevent the clots from enlarging. Although these medications are sometimes referred to as blood thinners, they do not thin the bot, but rather decrease the body’s ability to form clots.

Anticoagulants are the mainstay of initial treatment for deep vein thrombosis (DVT), which are blood clots that form in the deep vein system as well as to treat pulmonary embolism, blood clots in the lung, and acute arterial occlusion. They are also used to prevent blood clots from developing during various medical procedures and surgery.

Heparin has been the most widely used anticoagulant. Unfractionated heparin, given by intravenous infusion, has been part of the standard initial treatment for DVT. However, low molecular weight heparin (LMWH) has been replacing unfractionated heparin for prevention and treatment of blood clots. This is because LMWH can be given by subcutaneous injection using once-daily or twice-daily regimens. As a result, many patients with DVT can be treated as an outpatient, and can self-administer injections once they are taught how to do so. Another advantage of LMWH is they require much less blood monitoring because the dosage and anticoagulant effect is easier to predict, with dose based on body weight. Fondaparinux is a newer anticoagulant, also given by subcutaneous injection, that appears to be the most effective agent at preventing blood clots in patients undergoing orthopedic surgery. It has a similar rate of success as other anticoagulants in patients with DVT or pulmonary embolism.

Warfarin (Coumadin) is an oral medication used to prevent blood clots from forming or enlarging. It is used for some people with an irregular heart beat, patients with prosthetic valves, and to treat or prevent DVT and pulmonary embolism. In patients with DVT it is started once heparin has thinned the blood adequately. The heparin is continued until the warfarin reaches an appropriate level, as determined by blood tests. The warfarin is continued for different amounts of time depending on the particular clinical situation. Warfarin requires frequent blood monitoring and has many medication and food interactions as well as a risk of bleeding complications. As a result new oral anticoagulants have been developed that are designed to require little to no monitoring with a good safety profile.

You should be under close supervision by your physician while you are on anticoagulants. It is important that you avoid aspirin and other non-steroidal anti-inflammatory medications, such as ibuprofen) as they could increase the risk of bleeding. Contact sports should be avoided, as should situations that put you at risk for trauma.

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