Anticoagulants


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Anticoagulants

 

medicinal substances that suppress the activity of the clotting system of the blood and obstruct the formation of thrombi.

Anticoagulants affect various links in the process of blood clotting. One may distinguish anticoagulants with direct effect (heparin, hirudin, etc.), which lower the activity of thrombin in the blood; and anticoagulants with indirect effect (dicoumarin, “neodikumarin,” or Pelentan, phenin-dione, “sinkumar,” etc.), which disrupt the formation in the liver of prothrombin, which participates in blood coagulation. Certain preparations that are not classed as anticoagulants also decrease the coagulability of the blood, such as sodium citrate, sodium salicylate, and acetylsalicylic acid. (These bind the calcium in blood, which plays a part in blood clotting.) Anticoagulants are used in myocardial and pulmonary infarctions, in thrombotic and embolic insults, in cases of thrombophlebitis, and in other cases; they are used prophylactically in atherosclerosis of the coronary arteries and the cerebral blood vessels and in rheumatic mitral defects of the heart; in surgery they are used to prevent formation of thrombi in the postoperative period. Anticoagulants are contraindicated in cases of ulcers, kidney stones, diseases that incline to hemorrhage, and pregnancy.

REFERENCE

Zakusov, V. V. Farmakologiia, 2nd ed. Moscow, 1966.

A. A. TSOFINA

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He was coauthor of an analysis of 7,347 participants in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) who were on an oral anticoagulant. Fully 35% of them were also on aspirin.
A consultant pharmacist's assessment may include reviews of anticoagulant levels, lab work, physician orders and medication administration schedules.
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In a commentary published along with the Duke letter, one physician noted that a 66-year-old woman with one risk factor would have been considered at too-low risk to require aspirin under the old guidelines, but would now be considered at high risk and in need of anticoagulants.
However, with the development of new anticoagulants, the rate of medication use may increase even among persons at increased risk of hemorrhage.
In a project executed by PhD student Johan Holm, the initiation of amiodarone, an inhibitor of several enzymes of importance for the clearance of warfarin, instead resulted in an increased anticoagulant effect (INR > 3) in one individual out of three [2].
Knox sent the owl to the California Department of Fish and Wildlife and received this report back in December: "Gross necropsy revealed coagulopathy, and chemical analysis determined that the owl's liver contained three second generation anticoagulant rodenticides, two in potentially lethal concentrations.
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With current anticoagulants, however, such combination treatment is generally limited to 12 months because of an increased risk of major bleeding.
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Compared with patients without a history of cancer, those with a history of caner were less likely to fill prescriptions for anticoagulants (relative risk, 0.89); the results were similar across cancer types.

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