Anticoagulant
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Overview
An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some chemical compounds are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis equipment. They also have military applications, whereby their introduction into the wounds of enemy soldiers will make their treatment significantly more difficult.
As medications
Anticoagulants are given to people to stop thrombosis (blood clotting inappropriately in the blood vessels). This is useful in primary and secondary prevention of deep vein thrombosis, pulmonary embolism, myocardial infarctions and strokes in those who are predisposed.
Vitamin K antagonists
The oral anticoagulants are a class of pharmaceuticals that act by antagonizing the effects of vitamin K. Examples include warfarin. It is important to note that they take at least 48 to 72 hours for the anticoagulant effect to develop fully. In cases when any immediate effect is required, heparin must be given concomitantly. Generally, these anticoagulants are used to treat patients with deep-vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation (AF), and mechanical prosthetic heart valves.
Adverse effects
Patients aged 80 years or more may be especially susceptible to bleeding complications with a rate of 13 bleeds per 100 person-years.[1]
These oral anticoagulants are used widely as poisons for mammalian pests, especially rodents. (For details, see rodenticide and warfarin.)
Available agents
The most important oral anticoagulants are:
- Warfarin (Coumadin). This is the main agent used in the U.S. and UK
- Acenocoumarol and phenprocoumon This is used more commonly outside the U.S. and the UK
- Phenindione
Heparin and derivative substances
Heparin is a biological substance, usually made from pig intestines. It works by activating antithrombin III, which blocks thrombin from clotting blood. Heparin can be used in vivo (by injection), and also in vitro to prevent blood or plasma clotting in or on medical devices. Vacutainer brand test tubes containing heparin are usually colored green.
Low molecular weight heparin
Low molecular weight heparin is a more highly processed product that is useful as it does not require monitoring of the APTT coagulation parameter (it has more predictable plasma levels) and has fewer side effects.
Synthetic pentasaccharide inhibitors of factor Xa
- Fondaparinux is a synthetic sugar composed of the five sugars (pentasaccharide) in heparin that bind to antithrombin. It is a smaller molecule than low molecular weight heparin.
Direct thrombin inhibitors
Another type of anticoagulant is the direct thrombin inhibitor.[2] Current members of this class include argatroban, lepirudin, and bivalirudin. An oral direct thrombin inhibitor, ximelagatran (Exanta®) was denied approval by the Food and Drug Administration (FDA) in September 2004 [3] and was pulled from the market entirely in February 2006 after reports of severe liver damage and heart attacks. [4]
Anticoagulants outside the body
Laboratory instruments, test tubes, blood transfusion bags, and medical and surgical equipment will get clogged up and become nonoperational if blood is allowed to clot. Chemicals can be added to stop blood clotting. Apart from heparin, most of these chemicals work by binding calcium ions, preventing the coagulation proteins from using them.
- EDTA is denoted by mauve or purple caps on Vacutainer brand test tubes. This chemical strongly and irreversibly binds calcium. It is in a powdered form.
- Citrate is usually in blue Vacutainer tube. It is in liquid form in the tube and is used for coagulation tests, as well as in blood transfusion bags. It gets rid of the calcium, but not as strongly as EDTA. Correct proportion of this anticoagulant to blood is crucial because of the dilution. It can be in the form of sodium citrate or ACD.
- Oxalate has a similar mechanism to citrate. It is the anticoagulant used in fluoride (grey top) tubes.
For the meaning of more colors, see Vacutainer#including coagulants.
References
- ↑ Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007). "Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation". Circulation 115 (21): 2689-96. doi:10.1161/CIRCULATIONAHA.106.653048. PMID 17515465.
- ↑ Di Nisio M, Middeldorp S, Büller HR (2005). "Direct thrombin inhibitors". N. Engl. J. Med. 353 (10): 1028-40. doi:10.1056/NEJMra044440. PMID 16148288.
Interesting Links
See also
Major Drug Groups | |
|---|---|
| Gastrointestinal tract (A) | Antacids • Antiemetics • H₂-receptor antagonists • Proton pump inhibitors • Laxatives • Antidiarrhoeals |
| Blood and blood forming organs (B) | Anticoagulants • Antiplatelets • Thrombolytics |
| Cardiovascular system (C) | Antiarrhythmics • Antihypertensives • Diuretics • Vasodilators • Antianginals • Beta blockers • Angiotensin converting enzyme inhibitors • Antihyperlipidemics |
| Skin (D) | Emollients - Antipruritics |
| Reproductive system (G) | Hormonal contraception • Fertility agents • Selective estrogen receptor modulators • Sex hormones |
| Endocrine system (H) | Anti-diabetics • Corticosteroids • Sex hormones • Thyroid hormones |
| Infections and Infestations (J, P) | Antibiotics • Antivirals • Vaccines • Antifungals • Antiprotozoals • Anthelmintics |
| Malignant and Immune disease (L) | Anticancer agents • Immunostimulators • Immunosuppressants |
| Muscles, Bones, and Joints (M) | Anabolic steroids • Anti-inflammatories • Antirheumatics • Corticosteroids • Muscle relaxants |
| Brain and Nervous system (N) | Anesthetics • Analgesics • Anticonvulsants • Mood stabilizers • Anxiolytics • Antipsychotics • Antidepressants • Nervous system stimulants • Sedatives |
| Respiratory system (R) | Bronchodilators • Decongestants • Antihistamines |
WikiDoc Research Resources for Anticoagulant | |
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| Articles on Anticoagulant | Most recent articles on Anticoagulant • Most cited articles on Anticoagulant • Review articles on Anticoagulant • Articles on Anticoagulant in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Anticoagulant | Powerpoint slides on Anticoagulant • Images of Anticoagulant • Photos of Anticoagulant • Podcasts & MP3s on Anticoagulant • Videos on Anticoagulant |
| Evidence Based Medicine Regarding Anticoagulant | Cochrane Collaboration on Anticoagulant • Bandolier on Anticoagulant • TRIP on Anticoagulant |
| Cost Effectiveness of Anticoagulant | Cost Effectiveness of Anticoagulant |
| Clinical Trials Involving Anticoagulant | Ongoing Trials on Anticoagulant at Clinical Trials.gov • Trial results on Anticoagulant • Clinical Trials on Anticoagulant at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Anticoagulant | US National Guidelines Clearinghouse on Anticoagulant • NICE Guidance on Anticoagulant • NHS PRODIGY Guidance • FDA on Anticoagulant • CDC on Anticoagulant |
| Textbook Information on Anticoagulant | Books and Textbook Information on Anticoagulant |
| Pharmacology Resources on Anticoagulant | Dosing of Anticoagulant • Drug interactions with Anticoagulant • Side effects of Anticoagulant • Allergic reactions to Anticoagulant • Overdose information on Anticoagulant • Carcinogenicity information on Anticoagulant • Anticoagulant in pregnancy • Pharmacokinetics of Anticoagulant • |
| Genetics, Pharmacogenomics, and Proteinomics of Anticoagulant | Genetics of Anticoagulant • Pharmacogenomics of Anticoagulant • Proteomics of Anticoagulant |
| Newstories on Anticoagulant | Anticoagulant in the news • Be alerted to news on Anticoagulant • News trends on Anticoagulant |
| Commentary on Anticoagulant | Blogs on Anticoagulant |
| Patient Resources on Anticoagulant | Patient resources on Anticoagulant • Discussion groups on Anticoagulant • Patient Handouts on Anticoagulant • Directions to Hospitals Treating Anticoagulant • Risk calculators and risk factors for Anticoagulant |
| Healthcare Provider Resources on Anticoagulant | Symptoms of Anticoagulant • Causes & Risk Factors for Anticoagulant • Diagnostic studies for Anticoagulant • Treatment of Anticoagulant |
| Continuing Medical Education (CME) Programs on Anticoagulant | CME Programs on Anticoagulant |
| International Resources on Anticoagulant | Anticoagulant en Espanol • Anticoagulant en Francais |
| Business Resources on Anticoagulant | Anticoagulant in the Marketplace • Patents on Anticoagulant |
| Informatics Resources on Anticoagulant | List of terms related to Anticoagulant |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
