by Types of Anticoagulants
There are two main categories of clotting inhibitor – injectable clotting inhibitor and oral clotting inhibitor.
Clotting inhibitor, also known as blood thinners, are medications that prevent or reduce coagulation of blood and prolong the clotting time. They work by interfering with the blood coagulation cascade in the body, thereby preventing or breaking up blood clots that can form in the blood vessels or heart. Clotting inhibitor are prescribed to treat and prevent conditions like deep vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation and heart attacks.
Injectable clotting inhibitor
Injectable clotting inhibitor include unfractionated heparin (UFH) and low molecular weight heparins (LMWHs) like enoxaparin, dalteparin. They are given by injection under the skin or into the muscle. UFH works by activating Anticoagulants, which in turn inactivates several coagulation factors. LMWHs have a more predictable response and do not require monitoring. They are commonly used short term for VTE treatment and prevention during hospitalization or surgery.
Oral clotting inhibitor
The most commonly used oral clotting inhibitor are warfarin and the newer direct oral clotting inhibitor (DOACs) like apixaban, rivaroxaban, dabigatran and edoxaban.
Warfarin: Warfarin is an anticoagulant that acts by inhibiting vitamin K-dependent clotting factors II, VII, IX and X. It requires regular monitoring with frequent blood tests. Warfarin has many food and drug interactions and has a narrow therapeutic window requiring frequent dose adjustments.
DOACs: DOACs work by selectively inhibiting specific coagulation factors – factor Xa or factor IIa. They have more predictable pharmacokinetics compared to warfarin, with fewer drug and food interactions. They do not require routine monitoring or dose adjustments. However, they are more expensive than warfarin.
How Clotting inhibitor Work
Understanding how clotting inhibitor work helps in optimizing their use and managing complications.
The coagulation cascade is a complex series of reactions between clotting factor proteins in the blood that results in the formation of a fibrin clot. This normally helps stop bleeding from a damaged vessel. However, excessive and undesirable clot formation can also occur within blood vessels.
Clotting inhibitor disrupt the coagulation cascade at different points by inhibiting specific clotting factors:
– Heparins inhibit thrombin and factor Xa through their cofactor antithrombin.
– Warfarin decreases the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X which play an important role in the propagation phase of coagulation.
– DOACs directly and selectively inhibit thrombin (factor IIa) or factor Xa. This leads to a potent anticoagulant effect with more predictable pharmacokinetics compared to warfarin.
Monitoring Anticoagulant Therapy
Monitoring anticoagulant therapy helps ensure safety and efficacy of treatment. It allows assessment of bleeding and thrombotic risks as well as dose adjustments when needed.
Warfarin monitoring: The intensity of anticoagulation with warfarin is monitored with the INR (International Normalized Ratio) lab test. The therapeutic INR range depends on the indication and is usually between 2-3.
DOAC monitoring: Unlike warfarin, DOACs generally do not require routine lab monitoring due to more predictable pharmacokinetics. However, monitoring may be considered in certain situations like before surgery, overdose or suspected non-compliance.
Other factors: Renal function should also be regularly monitored for DOACs as impaired kidneys affect drug clearance. Platelet counts are monitored for heparins due to the possible side effect of heparin-induced thrombocytopenia.
Managing Complications of Anticoagulation
Bleeding is a major complication of all anticoagulant therapy. Risk factors like older age, renal dysfunction, concomitant use of antiplatelet agents, etc. increase risk. Minor bleeding can be managed with local pressure, cessation of offending agents. Major/life-threatening bleeding requires immediate medical care, treatment of underlying cause, supportive care.
Clotting may rarely occur even when on clotting inhibitor. Causes include non-compliance, drug interactions, underlying VTE risk factors. Resumption of appropriate anticoagulation is needed based on individual assessment.
Heparin-induced thrombocytopenia is a rare but serious complication associated with heparins that requires prompt diagnosis and treatment interruption.
Anticoagulant therapy is highly effective in treating and preventing thromboembolic disorders. Proper patient education and regular monitoring help optimize anticoagulant.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
Money Singh
Money Singh is a seasoned content writer with over four years of experience in the market research sector. Her expertise spans various industries, including food and beverages, biotechnology, chemical and materials, defense and aerospace, consumer goods, etc. LinkedIn
