- Atrial Fibrillation Slideshow: Causes, Tests and Treatment
- Atrial Fibrillation (A-Fib) Quiz: Test Your Medical IQ
- A Visual Guide to Heart Disease
- What are anticoagulants?
- Why are they used?
- List of anticoagulant side effects
- Drugs and herbal supplements that interact with anticoagulants
- Are anticoagulants, aspirin, and antiplatelets the same type of drug?
- Who shouldn't take anticoagulants?
- Different types or classes of anticoagulants
- List of brand and generic names, and preparations (oral, injection, tablet, pill, powder)
- Is it safe to take an anticoagulant if I'm pregnant or breastfeeding?
- Anticoagulant mechanism of action (how they work)
- Storage, preparations, and forms available in the US
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.
Why are they used?
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:
List of anticoagulant side effects
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
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Drugs and herbal supplements that 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 Jantoven or Coumadin 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.
Anticoagulant mechanism of action (how they 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 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.
Storage, preparations, and forms available in the US
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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Related Disease Conditions
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic). Symptoms of a stroke may include weakness, numbness, double vision or vision loss, confusion, vertigo, difficulty speaking, or understanding speech. A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.
Blood Clots (in the Leg)
Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract, and uterus. Risk factors include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms and treatment depend on the location of the clot.
How the Heart Works
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Heart Attack (Myocardial Infarction)
A heart attack occurs when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. Learn about warning signs, causes, complications, risk factors, and treatment.
Early Warning Signs and Symptoms of Stroke (FAST)
Stroke is a serious medical condition. If you think you or someone you know is having a stroke call 911 immediately. There are two main types of strokes, hemorrhagic and ischemic (the most common type). A hemorrhagic stroke occurs due to a blood vessel rupture in the brain. An ischemic stroke occurs when a blood clot becomes lodged in a blood vessel in the brain, which causes a loss of blood supply to the brain, possibly causing brain tissue death. FAST is an acronym that helps people identify stroke signs and symptoms so they can act fast and call 911. Face drooping, Arm weakness, and Speech difficulty are indicators that a person may be having a stroke and it is Time to seek emergency medical treatment. Additional signs and symptoms of stroke may include weakness, difficulty walking, blurred vision, dizziness, headache, confusion, difficulty speaking, and loss of sensation. Stroke is a major cause of death and disability in the U.S. Early identification and treatment of stroke helps reduce the risk of morbidity and mortality.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include: Smoking High blood pressure High cholesterol Diabetes Family history Obesity Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
Deep vein thrombosis (DVT) is a blood clot in the deep veins, and can be caused by broken bones, trauma to a limb, immobility, medications, smoking, cancer, genetic predisposition, and cancer. Symptoms of a deep vein thrombosis in a leg are swelling, tenderness, redness, warmth, and pain. Treatments for DVT include medications and surgery.
Transient Ischemic Attack (TIA, Mini-Stroke)
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Pulmonary Embolism (Blood Clot in the Lung)
A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
Arrhythmias (Heart Rhythm Disorders)
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Atrial Flutter vs. Atrial Fibrillation
Atrial flutter and atrial fibrillation (AFib) are two types of a heart problem called atrial tachycardia. Both of these conditions involve the heart's electrical activity, but they are not the same disease. Both diseases are serious and need medical treatment. Common symptoms of these diseases are similar and include: Fatigue Blurry vision Lightheadedness Palpitations Feeling like you may faint Serious symptoms of both conditions are similar and include: Fainting Sweating Severe shortness of breath Chest pain Atrial flutter and AFib are heart conditions that require medical diagnosis (ECG) and treatment by a doctor or other medical health-care professional.
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.
Atrial Fibrillation (AFib)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm, which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Atrial Flutter: ECG, Symptoms, and Treatments
Atrial flutter is a problem with the atria of the heart. In atrial flutter the atria of the heart rapidly and repeatedly beat due to an anomaly in the electrical system of the heart. It is a type of arrhythmia and can be dangerous because complications can develop easily. Signs and symptoms of atrial flutter include near fainting, palpitations, mild shortness of breath, and fatigue. While the exact cause of atrial flutter is not clearly understood, it's most likely related to your health, what medical conditions you certainly have, poor diet, lack of exercise, and drinking too much alcohol. Atrial flutter is diagnosed by physical examination, medical history, and a sawtooth ECG wave pattern.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a premature contraction.
Omega-3 Fatty Acids
Omega-3 fatty acids are essential fats that help decrease one's cholesterol and triglyceride levels as well as reduce the risk of coronary artery disease. Omega-3s are found in salmon, sardines, walnuts, and canola oil. These fats may help reduce the risk of ventricular fibrillation and sudden cardiac death.
Atrial Fibrillation (AFib) Symptoms and Signs
Atrial fibrillation or AFib is a type of heart rhythm abnormality. Early warning signs and symptoms of atrial fibrillation include chest pain, palpitations, shortness of breath, and lightheadedness. Treatment for atrial fibrillation includes medical procedures, surgery, and medication.
DVT (Deep Vein Thrombosis) During Pregnancy
Deep vein thrombosis or DVT is a condition in which a blood clot becomes embedded in one of the deep veins of the arms, thighs, pelvis, or lower legs. Warning signs and symptoms of DVT include pain, warmth, redness, swelling, leg cramps, and worsening leg pain in the affected extremity. Many conditions and other factors can cause DVTs, for example, during pregnancy including postpartum (6-8 weeks after delivery of the baby), obesity, heart attacks or heart failure, cancer, birth control pills (oral contraceptives), recent surgery, high altitudes, and advanced age. Treatment guidelines for DVT diagnosed during pregnancy is anticoagulation (anti-clotting) drugs, usually, low-molecular-weight heparins. DVT treatment may need to be continued postpartum. Warfarin (Coumadin, Jantoven) should not be used to treat DVT during pregnancy because it can harm the developing fetus.
Moyamoya disease is an inherited (genetic) progressive cerebrovascular disorder caused by arteries that are blocked at the base of the brain. Moyamoya means "puff of smoke" in Japanese. Signs and symptoms of Moyamoya disease in adults include fainting, and vision problems, and in children included may include headaches and speech problems. There are 6 stages of Moyamoya disease. Surgery is the preferred treatment for the disease, and there is no cure for Moyamoya disease, and it can be fatal.
Heart Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
Heart Attacks in Women
Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
Fitness: Exercises for a Healthy Heart
Regular exercise can help reduce the risk of heart disease. To achieve maximum benefits, do a mix of stretching exercises, aerobic activity, and strengthening exercise. Aim to get 20 to 30 minutes of aerobic exercise at least three to four times a week. Consult a doctor before exercising for the first time, especially if you have health problems.
Stress and Heart Disease
The connection between stress and heart disease is not clear. Stress itself may be a risk factor, or high levels of stress may make risk factors for heart disease worse. The warning signs of stress can be physical, mental, emotional, or behavioral. Reducing stressors in an individuals life not only can lead to a more productive life, but may also decrease the risk for heart disease and causes of heart disease.
Heart Disease in Women
Heart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
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.
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.
Treatment & Diagnosis
Medications & Supplements
- Ibuprofen and Plavix (Side Effects and Interactions)
- Lovenox (enoxaparin)
- Coumadin vs. Plavix (Differences and Similarities)
- dalteparin injection (Fragmin)
- Eliquis (apixaban)
- rivaroxaban (Xarelto)
- heparin (Hemochron, Hep-Lock)
- heparin lock flush-injection, Hep-Lock
- fondaparinux - injection, Arixtra
- dalteparin vial - injection, Fragmin
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American Heart Association. 2015. "What Are Anticoagulants and Antiplatelet Agents?"