- What Is
- Side Effects
- Drug Interactions
- vs. Aspirin & Antiplatelets
- Types & Classes
- Brand & Generic
- Pregnancy & Breastfeeding
- How They Work
- What Else to Know
What are anticoagulants?
An anticoagulant is a drug (blood thinner) that treats, prevents, and reduces the risk of blood clots-breaking off and traveling to vital organs of the body, which can lead to life threatening situations. They work by preventing blood from coagulating to form a clot in the vital organs such as the heart, lungs, and brain.
For example, a DVT or deep vein thrombosis (blood clot in the leg or lower extremity) can happen if you have a medical condition that keeps you immobile or if you have been sitting for n long period of time without getting up and stretching, like traveling by plane, car, or train. If the clot breaks off from the vein or artery of a leg it can get lodged in the blood vessels of the lung where it can form a clot in the lung (pulmonary embolism). This is a life threatening medical condition. Similarly, a stroke can be caused by a clot lodged in a vessel in the brain.
Anticoagulant treatment is used to prevent the formation of new blood clots, and to treat existing clots by preventing them from growing larger in size. It also reduces the risk of embolization of blood clots to other vital organs such as the lungs and brain.
What are anticoagulants used for?
An anticoagulant medicine is used in patients to prevent blood clots from forming in veins, arteries, the heart, and the brain of a patient. For example, if the clot travels to the patient's heart it can cause a heart attack or if one forms in the brain it may cause a stroke or TIA (mini-stroke, transient ischemic attack).
Examples of diseases and health conditions that require treatment with anticoagulants to reduce the risk of clots forming, or are used to prevent life-threatening problems include:
What are the side effects of anticoagulant blood thinners?
The most common side effect of treatment with anticoagulant medicine is bleeding. Treatment with these products may cause various degrees of bleeding, including fatal bleeds.
This list of adverse effects associated with anticoagulants are compiled from adverse effects listed for various anticoagulants and may not apply to every medicine.
Common side effects include:
- Abdominal pain
- Flatulence (intestinal gas)
- Local injection site reactions
- Bruises caused by trauma (ecchymosis)
Other side effects include:
- Hair loss (alopecia)
- Itching (pruritus)
- Changes is sense of taste
- Fainting (syncope)
- Shortness of breath
- Low blood pressure (hypotension)
- Chest pain
Serious side effects include:
- Cholesterol embolus syndrome
- Intraocular hemorrhage
- Groin hemorrhage
- Tissue necrosis
- Respiratory tract bleeding
- Hypersensitivity reaction
- Hemorrhagic stroke
- "Purple toe" syndrome
- Increased fracture risk with long-term usage
- Elevation of serum aminotransferases
What drugs interact with anticoagulants?
Treatment with more than one blood thinner or using medicine that can cause bleeding will increase the risk of bleeding from any anticoagulant. Examples of drugs that also can cause bleeding when they interact include:
- Antiplatelet medicine such as aspirin and other nonsteroidal anti-inflammatory medications (for example, ibuprofen [Motrin], naproxen [Aleve]), clopidogrel (Plavix), and prasugrel (Effient)
- Serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and paroxetine (Paxil).
- Garlic and ginkgo also increase the risk of bleeding when combined with another medicine that thins the blood because these herbs can cause bleeding when taken alone.
- Drug and herbal supplement interactions with warfarin
- amiodarone (Cordarone)
- trimethoprim/sulfamethoxazole (Bactrim)
- fluconazole (Diflucan)
- itraconazole (Sporanox)
- metronidazole miconazole
- voriconazole (Vfend)
- zafirlukast (Accolate)
- ciprofloxacin (Cipro)
- atorvastatin (Lipitor)
- clarithromycin (Biaxin)
- fluoxetine (Prozac)
- indinavir (Crixivan)
- ritonavir (Norvir)
Some drugs and herbal products that may reduce the anticoagulating effect of warfarin by increasing its breakdown include:
- St. John's wort
- carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol)
- rifampin, bosentan (Tracleer)
Use of warfarin with foods high in Vitamin K
Foods with high vitamin K content (for example, green leafy vegetables) reduce the anticoagulant effect of warfarin. It's important for patients to try to consume a consistent amount of vitamin K containing foods to avoid fluctuations in the effect of warfarin. A patient that regularly consumes high vitamin K containing foods may require a higher dose of warfarin (Jantoven) to achieve the desired level of anticoagulation.
Are anticoagulants, aspirin, and antiplatelets the same type of drug?
No. Anticoagulants and antiplatelets differ in how they work. Anticoagulants prevent blood coagulation by reducing the action of clotting factors directly or indirectly. Antiplatelets work by inhibiting the ability of platelets to participate in the clotting process. Aspirin is an example of an antiplatelet medication.
Who shouldn't take anticoagulants?
Anticoagulation therapy is not recommended for patients with certain diseases or health conditions because they increase the risk of bleeding. Patients who have any of the following health problems or are pregnant shouldn't use this type of therapy.
Different types or classes of anticoagulants
There are different types of anticoagulants, and they are classified by how they affect the normal coagulation pathway (see the mechanism of action section). The different classes are:
- Vitamin K antagonists (coumarin anticoagulants)
- Low molecular weight heparins (LMWH)
- Direct thrombin inhibitors
- Factor Xa Inhibitors
List of brand and generic names, and preparations (oral, injection, tablet, pill, powder)
Vitamin K antagonists
- warfarin (Coumadin, Jantoven) – oral tablets
Low molecular weight heparins (LMWH) and heparin (vials and syringes)
- bivalirudin (Angiomax) – powder for injection
- argatroban (Acova) - injection
- dabigatran (Pradaxa) – oral capsule
- antithrombin III (Thrombate III) – powder for injection
Factor Xa Inhibitors (These are relatively new anticoagulants)
Is it safe to take an anticoagulant if I'm pregnant or breastfeeding?
- Most anticoagulants have not been adequately studied in patients who are pregnant because clinical trials exclude them. Therefore, this type of therapy generally is avoided during pregnancy and should be used during pregnancy only if the potential health benefit justifies the potential dangers to the fetus.
- Warfarin, specifically, is a medication that should be avoided if you are pregnant or are planning to become pregnant. Birth defects and fetal bleeding have been reported during this type of therapy when taken during pregnancy. Be careful to not get pregnant if you are currently on this type of therapy. If you do become pregnant or are trying to conceive contact your doctor immediately.
- Enoxaparin is an anticoagulant medicine that does not cross the placenta and shows no evidence of effects on the fetus. It is often recommended by doctors for patients who are pregnant as an alternative to oral therapy with warfarin, which cannot be safely used during pregnancy.
- There is little data about the excretion of this medicine in breast milk. Available evidence suggests that warfarin is not secreted in breast milk. Since most medicines are excreted in breast milk, medical experts generally recommended that if you are receiving this type of therapy you should not breastfeed.
How do anticoagulants work?
How vitamin K antagonists (warfarin) cause anticoagulation
- Warfarin prevents the formation of a blood clots in patients by reducing the production of factors II, VII, IX, and X, and the anticoagulant proteins C and S by the liver. These factors are involved in the body's natural clotting process. The production of these factors by the liver are dependent on adequate amounts of vitamin K. Warfarin reduces the production of the factors because it antagonizes vitamin K. The dose of warfarin is carefully adjusted to achieve optimal anticoagulation while minimizing the risk of bleeding.
How low molecular weight heparins (LMWH) and heparin cause anticoagulation
- Heparin and low molecular weight heparins prevent a blood clot from forming by blocking the action of two of the 12 clot-promoting proteins in the blood (factors X and II) whose action is necessary for blood to clot. Low molecular weight heparins are produced by chemically breaking heparin into smaller-sized molecules. Unlike heparin, medical professionals do not monitor the effect of low molecular weight heparins with blood tests and the dose of a low molecular weight heparin is not titrated.
How thrombin inhibitors cause anticoagulation
- Thrombin inhibitors work by blocking the action of thrombin, a protein that is necessary for the coagulation of blood and the formation of a blood clot. Reducing the action of thrombin reduces the ability of blood to clot.
How factor Xa inhibitors cause anticoagulation
- Factor Xa inhibitors are novel anticoagulants. They block the action of factor Xa which is an important protein in the coagulation cascade that causes blood to clot. Reducing the action of factor Xa reduces the ability of blood to clot.
What else should I know about anticoagulants?
Drugs in this class are available as tablets, capsules, powder for injection, prefilled syringes, and in vials containing a solution for injection. Some intravenous anticoagulants (for example, bivalirudin, and heparin) are administered via an intravenous infusion while receiving medical care in the hospital.
Oral anticoagulants are stored at room temperature. Prefilled syringes and multiple dose vials of low molecular weight heparins, and heparin vials are also stored at room temperature.
Anticoagulants are drugs that inhibit blood clots from forming in the veins and arteries of the body. There are a variety of uses for these drugs, which include the treatment or prevention of deep vein thrombosis (DVT), blood clots in the lung (pulmonary embolism), stroke, blood clots during AFib, and heart attacks.
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Atrial Fibrillation (AFib)
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Transient Ischemic Attack (TIA, Mini-Stroke)
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Atrial Flutter vs. Atrial Fibrillation
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Heart Attack (Myocardial Infarction)
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Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
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Peripheral Vascular Disease
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include intermittent leg pain while walking, leg pain at rest, numbness in the legs or feet, and poor wound healing in the legs or feet. Treatment for peripheral artery disease include lifestyle measures, medication, angioplasty, and surgery.
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Atrial Flutter: ECG, Symptoms, and Treatments
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Heart Attack vs. Stroke Symptoms, Differences, and Similarities
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Heart Attack vs. Heartburn
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Omega-3 Fatty Acids
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What Are the Four Signs of an Impending Heart Attack?
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Atrial Fibrillation (AFib) Symptoms and Signs
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Heart Attack Treatment
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DVT and Birth Control Pills (Oral Contraceptives)
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What Are the Differences Between Heart Attack, Cardiac Arrest and Stroke?
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Heart Disease in Women
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How Do You Know If You Have a Blood Clot in Your Leg?
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DVT (Deep Vein Thrombosis) During Pregnancy
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Heart Attack Pathology: Photo Essay
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Is Lupus and Lupus Anticoagulant the Same?
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Can DVT Cause Acute Limb Ischemia?
Acute limb ischemia caused by DVT is a rare and potentially fatal complication that can result in arterial circulation impairment, tissue ischemia, or limb gangrene.
Heart Attack Prevention
Heart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management. Symptoms of heart attack in men and women include chest discomfort and pain in the shoulder, neck, jaw, stomach, or back.
Smoking and Heart Disease
Smoking increases the risk of heart disease in women and men. Nicotine in cigarettes decrease oxygen to the heart, increases blood pressure, blood clots, and damages coronary arteries. Learn how to quit smoking today, to prolong your life.
Heart Disease Treatment in Women
Heart disease treatment in women should take into account female-specific guidelines that were developed by the American Heart Association. Risk factors and symptoms of heart disease in women differ from those in men. Treatment may include lifestyle modification (diet, exercise, weight management, smoking cessation, stress reduction), medications, percutaneous intervention procedure (PCI), and coronary artery bypass grafting (CABG). Heart disease is reversible with treatment.
What Are the First Signs of a Heart Attack in a Woman?
A heart attack happens when a blocked artery prevents blood from reaching your heart. Some people, especially women, may have a heart attack without any chest pain or pressure, but may experience chest tightness and aching.
What Does a Blood Clot Feel Like?
Blood clots are semi-solid masses of blood that may be immobile (thrombosis) and impede blood flow or dislodge to other parts of the body (embolism). Deep vein clots, if dislodged, can travel through veins through the lungs to the arteries in the lungs. This is referred to as a pulmonary embolism and can be deadly. Blood clots can also lead to a heart attack or stroke.
How Do I Know if I'm Having a Panic Attack or Heart Attack?
If your chest feels tight and you find it hard to breathe, is it a heart attack or a panic attack? You age, how long symptoms last, and what you are doing when symptoms come on help determine if you are having a panic attack or a heart attack.
Vitamins & Exercise: Heart Attack Prevention Series
Vitamins and exercise can lower your risk for heart attack and heart disease. Folic acid, vitamins, and homocysteine levels are interconnected and affect your risk for heart disease or heart attack. For better heart health, avoid the following fried foods, hard margarine, commercial baked goods, most packaged and processed snack foods, high fat dairy, and processed meats such as bacon, sausage, and deli meats.
Can Angina Lead to a Heart Attack?
Angina, or angina pectoris, is a sudden chest pain caused by low blood flow to the heart. Yes, some types of angina attacks can lead to heart complications.
Heart Attack Prevention Overview
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack also is a significant cause of heart failure. The process of developing atherosclerosis (hardening of the arteries) begins early in life. Heart attack prevention should begin in childhood because the atherosclerosis process can not be reversed. The risk of having a heart attack increases if you have diseases or conditions such as high blood pressure, diabetes, and other heart conditions.
Can You Have Sex Right After a Heart Attack?
It is important not to put any pressure on yourself or your heart after heart attack. Initially, you might feel less interested in sex. That is perfectly normal, and the feeling goes away quickly.
What Does a Sudden Heart Attack Feel Like?
In most cases, a sudden heart attack may feel like pain, pressure, fullness, or squeezing in the chest that lasts for a few minutes or goes away and comes back.
Treatment & Diagnosis
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- Atrial Fibrillation A-Fib FAQs
- Deep Vein Thrombosis and Pulmonary Embolism FAQs
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- Heart Attack Prevention From a Doctor's Perspective
- How Pie Prevents Blood Clots
- What Should Cholesterol Levels Be After Heart Attack?
- Can Gallbladder Problems Cause Blood Clots?
- Do Women Have Different Heart Attack Symptoms?
- Will My Diet Slip Increase the Risk of Heart Attack?
Medications & Supplements
Prevention & Wellness
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
American Heart Association. 2015. "What Are Anticoagulants and Antiplatelet Agents?"