Indirect anticoagulants: indications and contraindications. Tools Overview

Latest generation anticoagulants

Anticoagulants are medications that reduce blood viscosity and the formation of blood clots in blood vessels. These drugs are an integral part of the treatment of varicose veins, various thromboses, phlebothrombosis and related pathologies.

Clots in blood vessels are formed by the gluing of white blood cells - platelets and freely circulating proteins called coagulation factors. Some drugs have a direct effect on the activity of blood cells and certain enzymes, while others act on the liver and suppress the synthesis of substances that regulate thrombus formation. Let's look at what anticoagulants are, their dosage forms, and look at the benefits and features of their use.

When are medications prescribed?

Before starting treatment, it is very difficult to make a choice - the market offers a variety of drugs, from intravenous injections to oral anticoagulants. Despite the variety of forms, the indications for use of these products are the same. These include:

The presence of atherosclerotic plaques;
Thrombophlebitis of veins;
Acute and chronic thrombosis;
Hemorrhages of any etiology;
Various lesions of the membranes of the heart;
Mitral valve defects;
Damage to the aorta;
Insufficiency of venous valves and blood stagnation;
Thromboembolism or vascular blockage;
DIC syndrome;
Heart rhythm disorders;

The listed diseases directly or indirectly affect the blood, form complications in the form of increased coagulability and the formation of blood clots - this condition requires appropriate therapy. Anticoagulants are prescribed not only for the treatment, but also for the prevention of blood diseases, as well as the cardiovascular system.

Despite their high effectiveness, the drugs have some contraindications:

Ulcerative lesions of the upper digestive system;
Internal bleeding;
Diseases of the pancreas, liver, kidneys and heart;
Lack of vitamins;
Inflammatory diseases of the lungs and heart;
Heart attacks and strokes;
Thrombocytopenic purpura;
Cerebral aneurysm;
Hemorrhagic retinopathy;
Crohn's disease;
Various forms of leukemia;
Age over 65 years;
The period of bearing a child and breastfeeding.

Pregnancy is an absolute contraindication to the use of these drugs, since any anticoagulant is a drug that changes the quality of blood, which can affect the development of the fetus.

List of main side effects from taking anticoagulants:

Allergic reaction;
Skin lesions;
Digestive disorders;
Gradual destruction of bone tissue;
Hair loss.

In most clinical cases, complications develop with an overdose - when the daily dose of the drug exceeds the maximum permissible, which leads to all sorts of disorders.

Classification and mechanism of action

Blood is a fluid medium of the body, which is tissue. One of its cells are protective bodies - platelets, whose function is to prevent the development of bleeding. Normally, their vital functions are regulated by special enzymes that are synthesized naturally in the body.

When damage occurs, platelets receive a signal, are drawn into the pathological area and clog the wound. If the integrity of the tissue is not compromised, white cells circulate freely through the bloodstream without sticking together or forming a clot. Taking anticoagulants is required for some diseases, when blood clotting increases - the concentration of active substances decreases, platelets begin to stick together, die and form blood clots.

The classification of anticoagulants is based on their mechanism of action. According to this criterion, two groups of drugs are distinguished:

Direct anticoagulants - have a direct effect on the process of thrombus formation - suppress the formation of thrombin, slow down the activity of fibrinogen and prevent it from degenerating into fibrin. In total, this mechanism of action of anticoagulants reduces the ability of platelets to form clots;
Indirect anticoagulants - can reduce the formation of blood clotting factors in the liver. As a result, platelets become less active, reducing the likelihood of blood clots.

Despite the different mechanisms, direct and indirect anticoagulants are equally used to treat blood and vascular diseases.

On a note!
The pathogenesis of diseases, the characteristics of clinical manifestations and the severity of symptoms play a key role in the choice of the drug that the attending physician will prescribe.

Direct anticoagulants

Direct anticoagulants have a direct effect on platelets and their enzymes, reducing the percentage of formation of sediments and clots. For this purpose, heparin-based drugs, selective inhibitors of factor CA (cholinesterase) and hirudin preparations are used. We will not compile a list of anticoagulant drugs, but will analyze the main representatives sequentially.

Heparin

Acts directly on thrombin, reduces its activity, and also prevents the transition of fibrinogen to fibrin. When used in large doses, it promotes dilation of blood vessels, reduces their permeability, improves blood flow through bypass vessels and reduces platelet aggregation. The most optimal is the use of intravenous injections, as well as subcutaneously or intramuscularly.

Due to the large number of side effects, injections are performed in a medical facility under the supervision of a physician. Ointments and gels for external use are widely used. The price of the drug is 250-400 rubles.

Low molecular weight heparins

These are the latest generation anticoagulants, which inhibit cholinesterase (CA) and angiotensin-III, providing a high therapeutic effect. An important positive point is the selectivity of action - the drugs suppress platelet activity, but have little effect on blood clotting. Therefore, the drugs have minimal side effects, do not cause bleeding, and are widely used in clinical practice.

The main representatives of this group of drugs:

Dalteparin (Fragmin) is available in the form of injection solutions that are administered intravenously or subcutaneously. Intramuscular injections are strictly prohibited. It has a weak effect on blood clotting, but reduces platelet sedimentation. At significant dosages, it reduces inflammation and immune activity. Average cost 2500-3000 rubles;
Enoxaparin (Flenox, Novoparin, Clexane) - injections of this drug are given subcutaneously, after which almost all of it is absorbed into the blood. The action begins virtually instantly and lasts several hours. The price of the medicine is from 800 to 1200 rubles;

Nadroparin (Fraxiparin) is widely used for atherosclerosis, since the action of the drug is aimed not only at reducing thrombus formation, but also at combating inflammation and reducing lipid levels in the blood. Most often, the medicine is administered subcutaneously, but intravenous infusions are also permitted under the supervision of the attending physician. You can purchase the solution for 2-2.5 thousand rubles;
Bemiparin (Cibor) is a classic anticoagulant that effectively reduces the aggregation of white blood cells and the formation of sediment. Available in solution for injection, the most effective administration is subcutaneous.

Expert opinion!
Doctors strongly do not recommend using several types of anticoagulants at the same time - this will not increase the effect of the drugs, and the risk of complications increases. It is recommended to start treatment with injections, gradually moving to tablet forms.

Heparinoids

These drugs selectively inhibit CA without affecting angiotensin-III. The drugs have a fibrinolytic effect, reduce the formation of sediments in the blood, and also reduce the concentration of fats.

Classic representatives of this group:

Pentosan Polysulfate - sold in tablets and ampoules at a cost of 2-2.5 thousand rubles. The greatest effectiveness is observed from the use of injections;
Wessel Due F (Sulodexin) - available in the form of a solution for injections, as well as capsules for internal use. The initial course includes injections for 15-20 days, then switch to capsules, which are taken for 1-2 months. The average price is 2000 rubles.

Anticoagulants based on hirudin

The action of the active substance is aimed at reducing the formation of blood clots. Two groups of drugs are used to treat diseases:

Xarelto (Rivaroxaban) - sold in tablets, costing 1,500 rubles per pack. The drug selectively inhibits cholinesterase;
Arixtra (Fondaparinux) - injections are given intravenously or subcutaneously; intramuscular injection is contraindicated. The drug is expensive, the average cost is 7,000 rubles.

Indirect anticoagulants

Indirect anticoagulants act on the liver, after which complex mechanisms are launched that affect the activity of blood clotting enzymes. The most popular are: Phenylin and coumarin anticoagulants.

Sinkumar (Acenocoumarol) is a good drug, but the effect of the tablets begins 1-2 days after administration. To select the dosage, it is recommended to consult your doctor. Average cost – 600-800 rubles;
Trombarin (Pelentan, Dicumarin, Neodicoumarin) - sold in tablets, the action begins in 2-3 hours. The dose and course of treatment are selected after passing medical tests. Price 700-1000 rubles;
Warfarin is well absorbed in the intestines, has a rapid effect on the liver and improves blood counts. The tablets are inexpensive - you can buy them for 80-100 rubles;
Phenilin (Phenindione) - the release form is similar to previous drugs, the effect begins 7-12 hours after administration. The dose is prescribed and adjusted by the attending physician depending on laboratory parameters. The average price of a medicine is 100-150 rubles.

The therapeutic effect of indirect-acting anticoagulants, in contrast to direct-acting drugs, is observed after a few hours - for this it is necessary that they accumulate in the liver cells. It cannot be said that these are the best anticoagulants in tablets - but treatment can be carried out at home.

Most drugs should not be taken with alcohol - alcohol enhances the therapeutic effect, causing the risk of bleeding and other adverse reactions.

New generation anticoagulants

Recently, scientists have been striving to develop new drugs with better effectiveness, the action of which will be aimed directly at blocking the necessary enzymes that cause the disease. An important goal is to create drugs that have a minimum of side effects, which can be treated independently by both adults and children.

Recently, new oral anticoagulants - tablet forms - have gained widespread popularity. Such drugs include:

Apixaban;
Dabigatran;
Rivaroxaban;
Edoxaban.

Medicines are direct anticoagulants - they affect platelets and their enzymes. No indirect-acting drugs have been developed at this time.

Help with overdose

The most common complication is poisoning, which can be caused by a violation of the dose of the drug or as a result of its use with alcoholic beverages.

In this situation, it is urgent to take the following measures:

Call emergency medical assistance;
Place the patient in a supine position;
If an overdose is caused by taking pills, urgently rinse the stomach, drink a large amount of water and induce artificial vomiting.

The doctor will examine the patient and, if necessary, put in a drip with saline or vitamin K, which causes the opposite effect. If the patient's condition is severe, hospitalization and blood plasma transfusion will be required.

Anticoagulants are excellent drugs used to treat most diseases of the blood and cardiovascular system. Medicines can act directly by inhibiting platelet activity or indirectly through the liver. You should be more careful when using them - follow the dosage, do not combine therapy with alcohol and do not conduct it during pregnancy or during breastfeeding. If there are signs of poisoning, consult a doctor.

Blood clotting is a rather complex, multi-stage process in which enzymes play a major role. With a lack of specific protein, clotting indicators worsen. This may indicate the presence of pathology and deterioration in the functioning of the entire body. In order to first of all, it is necessary to undergo an examination and establish the cause of the disease. After this, the specialist will select the optimal treatment method.

possible reasons

Specific proteins - fibrinogens, which are involved in the formation of fibrin blood clots - are responsible for normality. Various factors can affect the level of this substance. Experts call the following deviations the main reasons for this pathological condition:

disturbances in the functioning of the liver (tumors, infectious pathologies);
malfunction of the immune system;
DIC syndrome (pathology of hemostasis);
thrombophilia;
Iron-deficiency anemia;
thrombocytopenia;
vitamin deficiency;
hereditary predisposition;
long-term use of drugs from the group of anticoagulants and angiogenesis inhibitors.

If a process such as blood clotting is disrupted, frequent nosebleeds and the causeless appearance of bruises on the body are observed. One of the symptoms is also gum bleeding. With the help of systemic and local drugs, blood clotting can be increased. Such medications should be prescribed by a doctor after diagnosis. The patient must undergo laboratory tests and undergo an ultrasound examination of the liver to exclude the development of cirrhosis.

What to do if you have poor blood clotting?

Patients who have a history of such a diagnosis should know how to protect themselves from the development of various types of complications. It is highly undesirable to take any medications or try traditional medicine recipes on yourself. Only after finding out the reasons for the deviation and receiving doctor’s recommendations regarding treatment should you begin therapy.

In addition to medicinal effects, attention must be paid to the nutritional system. Eating certain foods will help improve blood clotting rates. A negative psycho-emotional state and poor nutrition lead to changes in the production of fibrinogen protein.

Treatment with drugs

Depending on the etiology of the pathological condition, the specialist prescribes the patient certain drugs that increase blood clotting. Such medications include:

coagulants - directly affect the production of fibrinogen (“Vikasol”, “Thrombin”);
synthetic drugs that improve blood clotting (aminocaproic acid);
agents that stimulate the formation of blood clots;
preparations of animal origin (“Aprotinin”, “Pantripin”);
drugs of synthetic origin that reduce the permeability of vascular walls (“Rutin”, “Androxon”);
herbal preparations that reduce vascular permeability (nettle, arnica).

Before taking any medicine, you must carefully study the instructions and make sure there are no contraindications.

The drug "Vikasol"

Antihemorrhagic drugs that increase blood clotting can improve the production of prothrombin in the liver and enhance the production of hemocoagulation factors. A doctor should prescribe such medications, determining the appropriate dosage and duration of therapy for a particular patient.

The hemostatic drug "Vikasol" is an indirect coagulant and is prescribed to enhance blood clotting. This is a vitamin preparation that is an analogue (synthetic, water-soluble) of vitamin K. The active ingredient in the composition is sodium menadione bisulfite (15 mg). The drug is available in the form of an injection solution and tablets.

Indications

The drug can be used as part of complex treatment for uterine bleeding, hemorrhagic disease (including in newborns), and menorrhagia.

Indications for the use of Vikasol also include the following conditions:

frequent nosebleeds;
vitamin K hypovitaminosis;
hepatitis;
bleeding during surgery;
cirrhosis of the liver.

To prevent bleeding, the medicine is prescribed for long-term treatment with anticoagulants and for pregnant women in the last trimester.

The drug "Rutin"

Medicines that increase blood clotting from the group of flavonoids have a therapeutic effect by reducing capillary fragility. One of these drugs is Rutin. The active substance - rutoside - replenishes the deficiency, strengthens the vascular walls, relieves inflammation and swelling. The drug is available in the form of tablets and powder, which contain 20 mg of rutoside.

The drug will be effective for various pathological conditions: hemorrhoids, lack of vitamin P, lymphostasis, superficial thrombophlebitis, chronic venous insufficiency. It is recommended to take “Rutin” three times a day, 20-50 mg at a time.

Contraindications and side effects

The drug should not be prescribed to pregnant women in the first trimester, as well as to patients with hypersensitivity to the components in the composition. Side effects in the form of headache, allergic skin reaction, heartburn, diarrhea, belching develop in rare cases.

Traditional medicine recipes

Plants will help prevent bleeding from damaged skin. Medicinal herbs that increase blood clotting are used to prepare decoctions, lotions and compresses.

Yarrow has the necessary property. The plant has a positive effect on the condition of blood vessels, stops the inflammatory process, and accelerates tissue regeneration. Dry herb (15 g) is poured with warm water (200 ml) and boiled for 15 minutes. After which the decoction should be infused, strained and taken 1 tbsp. spoon before meals three times a day.

For any bleeding, it is useful to take a decoction of nettles. To prepare it, you need to take 10 g of dry grass and pour a glass of boiling water. Steam the drink for 20 minutes, then filter and take a tablespoon 3 times a day.

Arnica will help increase blood clotting. The drug based on the flowers of the plant can be purchased in the form of drops or an infusion can be prepared at home. For a glass of boiling water (200 ml) you need to take 2 tbsp. spoons of dried flowers and steam for 40 minutes. Take 1 tbsp. spoon 2-3 times a day.

Diet

Experts recommend including foods that increase blood clotting in your diet. These include spinach, cabbage (regular and cauliflower), corn, carrots, red berries, bananas, walnuts. Eating buckwheat porridge, legumes, animal fats, white bread, and liver will be beneficial.

In order to increase blood clotting, these products should be present in the daily menu. The diet should be varied. The products listed should only complement it. Dietary nutrition and traditional medicine recipes for problems with blood clotting will help people who have contraindications to drug therapy. This method of maintenance treatment is completely safe for children.

Pathological tachycardia requires medical or surgical treatment

Complications caused by vascular thrombosis are the main cause of death in cardiovascular diseases. Therefore, in modern cardiology, great importance is attached to preventing the development of thrombosis and embolism (blockage) of blood vessels. Blood coagulation in its simplest form can be represented as the interaction of two systems: platelets (cells responsible for the formation of a blood clot) and proteins dissolved in the blood plasma - coagulation factors, under the influence of which fibrin is formed. The resulting thrombus consists of a conglomerate of platelets entangled in fibrin threads.

To prevent the formation of blood clots, two groups of drugs are used: antiplatelet agents and anticoagulants. Antiplatelet agents prevent the formation of platelet clots. Anticoagulants block enzymatic reactions leading to the formation of fibrin.

In our article we will look at the main groups of anticoagulants, indications and contraindications for their use, and side effects.

Depending on the point of application, direct and indirect anticoagulants are distinguished. Direct anticoagulants inhibit thrombin synthesis and inhibit the formation of fibrin from fibrinogen in the blood. Indirect anticoagulants inhibit the formation of blood clotting factors in the liver.

Direct coagulants: heparin and its derivatives, direct thrombin inhibitors, as well as selective inhibitors of factor Xa (one of the blood clotting factors). Indirect anticoagulants include vitamin K antagonists.

Vitamin K antagonists

Indirect anticoagulants are the basis for the prevention of thrombotic complications. Their tablet forms can be taken for a long time on an outpatient basis. The use of indirect anticoagulants has been proven to reduce the incidence of thromboembolic complications (stroke) in the presence of an artificial heart valve.

Phenyline is not currently used due to the high risk of unwanted effects. Sinkumar has a long period of action and accumulates in the body, so it is used infrequently due to the difficulties of monitoring therapy. The most common vitamin K antagonist drug is warfarin.

Warfarin differs from other indirect anticoagulants in its early effect (10–12 hours after administration) and the rapid cessation of unwanted effects when the dose is reduced or the drug is discontinued.

The mechanism of action is associated with the antagonism of this drug and vitamin K. Vitamin K is involved in the synthesis of some blood clotting factors. Under the influence of warfarin, this process is disrupted.

Warfarin is prescribed to prevent the formation and growth of venous blood clots. It is used for long-term therapy in atrial fibrillation and in the presence of intracardiac thrombus. In these conditions, the risk of heart attacks and strokes associated with blockage of blood vessels by detached particles of blood clots is significantly increased. The use of warfarin helps prevent these serious complications. This drug is often used after a myocardial infarction to prevent a recurrent coronary accident.

After heart valve replacement, warfarin is required for at least several years after surgery. It is the only anticoagulant used to prevent the formation of blood clots on artificial heart valves. You need to take this medicine regularly for some thrombophilias, in particular antiphospholipid syndrome.

Anticoagulants are drugs that prevent the formation of blood clots in blood vessels. This group includes 2 subgroups of drugs: direct and indirect anticoagulants. We already talked about it earlier. In the same article, we briefly described the principle of normal functioning of the blood coagulation system. In order to better understand the mechanisms of action of indirect anticoagulants, we strongly recommend that the reader familiarize himself with the information available there, with what happens normally - knowing this, it will be easier for you to navigate which phases of coagulation are affected by the drugs described below and what they involve the effects they have.

Mechanism of action of indirect anticoagulants

Drugs in this group are effective only when administered directly into the body. When mixed with blood in the laboratory, they do not affect clotting. They do not act directly on the blood clot, but have an effect on the coagulation system through the liver, causing a series of biochemical reactions, as a result of which a condition similar to hypovitaminosis K develops. As a result, the activity of plasma blood clotting factors decreases, thrombin is formed more slowly, which means it is formed more slowly thrombus.

Pharmacokinetics and pharmacodynamics of indirect anticoagulants

These drugs are absorbed well and fairly quickly in the gastrointestinal tract. With the blood flow they reach various organs, mainly the liver, where they carry out their effects.
The rate of onset, duration of effect, and half-life vary among drugs in this class.

They are excreted from the body mainly in urine. Some members of the class turn their urine pink.

Medicines in this group exert their anticoagulant effect by disrupting the synthesis of blood clotting factors, thereby gradually reducing the rate of this process. In addition to the anticoagulant effect, these drugs reduce the tone of the muscles of the bronchi and intestines, increase the permeability of the vascular wall, reduce the lipid content in the blood, inhibit the reaction of antigen-antibody interaction, and stimulate the excretion of uric acid from the body.

Indications and contraindications for use

Indirect anticoagulants are used for the prevention and treatment of thrombosis and thromboembolism in the following conditions:

after surgical interventions on the heart and blood vessels;
at ;
PE – for pulmonary embolism;
at ;
with aneurysm of the left ventricle;
at ;
with thromboangiitis obliterans;
with obliterating endarteritis.

Contraindications to the use of drugs in this group are:

hemorrhagic diathesis;
hemorrhagic stroke;
other diseases accompanied by;
increased vascular permeability;
severe renal and liver dysfunction;
pericarditis;
myocardial infarction accompanied by high blood pressure;
pregnancy period;
These drugs should not be taken during the period (2 days before the planned start, their medication is discontinued) and in the early postpartum period;
Prescribe with caution to elderly and senile patients.

Features of the action and use of indirect anticoagulants

Unlike direct-acting anticoagulants, the effect of drugs in this group does not appear immediately, but as the active substance accumulates in organs and tissues, that is, slowly. On the contrary, they act for a longer period of time. The speed, strength of action and degree of cumulation (accumulation) vary among different drugs of this class.

They are used exclusively internally or orally. They cannot be used intramuscularly, intravenously or subcutaneously.

Therapy with indirect-acting anticoagulants should not be stopped immediately, but gradually - slowly reducing the dose and increasing the time between doses of the drug (up to 1 time per day or even every other day). Abrupt withdrawal of the drug may lead to a sudden compensatory increase in the level of prothrombin in the blood, which will cause thrombosis.

If an overdose of drugs from this group is used or if they are used for too long, they can become a cause, and it will be associated not only with a decrease in blood clotting ability, but also with an increase in the permeability of the capillary wall. Less commonly in this situation, bleeding from the oral cavity and nasopharynx, gastrointestinal bleeding, hemorrhage into the muscles and joint cavity develop, and micro- or macrohematuria also appears.

To avoid the development of the complications described above, it is necessary to carefully monitor the patient’s condition and laboratory indicators of blood clotting during treatment with indirect anticoagulants. Once every 2-3 days, and in some cases more often, the prothrombin time should be determined and the urine examined for the presence of red blood cells (hematuria, that is, the presence of blood in the urine, is one of the first signs of a drug overdose). For more complete control, in addition to the prothrombin content in the blood, other indicators should be determined: heparin tolerance, recalcification time, prothrombin index, plasma fibrinogen, prothrombin content using a 2-step method.

Preparations of the salicylate group (in particular, acetylsalicylic acid) should not be prescribed simultaneously with these drugs, since they increase the concentration of free anticoagulant in the blood.

There are actually few drugs in the group of indirect-acting anticoagulants. These are neodicoumarin, acenocoumarol, warfarin and phenindione.
Let's look at each of them in more detail.

Neodicoumarin (Pelentan, Trombarin, Dicumaril)

When taken orally, it is absorbed relatively quickly, the half-life is 2.5 hours, and is excreted in the urine not in its original form, but in the form of metabolic products.

The expected effect of the drug begins to appear 2-3 hours after taking it, reaches a maximum in the period of 12-30 hours and continues for another two days after discontinuation of the drug.

Used independently or in addition to heparin therapy.

Release form: tablets.

Dosage according to the scheme, the maximum daily dose is 0.9 g. The dose is selected depending on the prothrombin time.

Acenocoumarol (Sincumar)

Well absorbed when taken orally. It has a cumulative effect (that is, it acts when a sufficient amount of it accumulates in the tissues). The maximum effect is observed 24-48 hours after the start of treatment with this drug. After discontinuation, its normal prothrombin level is determined after 48-96 hours.

Release form: tablets.

Taken orally. On the first day, the recommended dose is 8-16 mg; subsequently, the dosage of the drug depends on prothrombin values. As a rule, the maintenance dose is 1-6 mg per day.
Increased sensitivity of the patient's body to this drug is possible. If allergic reactions occur, it must be discontinued.

Fenindione (Fenilin)

A decrease in blood clotting ability is observed 8-10 hours after taking the drug, reaching a maximum after about a day. Has a pronounced cumulative effect.

Release form: tablets.

The initial dose is 0.03-0.05 g three times a day in the first 2 days. Further dosages of the drug are selected individually depending on blood parameters: the prothrombin index should not be less than 40-50%. The maximum single dose is 0.05 g, daily dose is 200 mg.

During treatment with phenyline, skin staining and urine color change may occur. If these symptoms occur, phenindione should be replaced with another anticoagulant.

Warfarin (Warfarin)

Absorbed completely in the gastrointestinal tract. The half-life is 40 hours. The anticoagulant effect begins 3-5 days after the start of treatment and continues for 3-5 days after discontinuation of the drug.

Available in tablets.
Treatment is started with 10 mg once a day, after 2 days the dosage is reduced by 1.5-2 times - to 5-7.5 mg per day. Therapy is carried out under the control of the blood indicator INR (international normalized ratio). In certain clinical situations, for example, in preparation for surgical treatment, the recommended dosages of the drug vary and are determined individually.

What are oral anticoagulants? This is a special type of medicines whose action is aimed at eliminating the processes of thrombosis. As a rule, these drugs are prescribed to patients who are at high risk of developing blood clots in their blood vessels.

A stable state of the circulatory system is possible when the coagulation and anticoagulation components are in balance. In this case, the outflow of blood occurs smoothly, evenly, and there are no prerequisites for the formation of blood clots. If this balance is disturbed, intravascular coagulation syndrome develops, in which the resulting blood clot can cause sudden death. In medical practice, there are many factors known to contribute to vein blockage:

stroke;
myocardial infarction;
injuries of blood vessels and veins of various origins;
sepsis.

The treatment protocol for these diseases necessarily involves the use of new generation anticoagulants. They provide blood thinning. These medications are designed to restore blood flow through the veins and vessels and minimize the risk of blood clots. Anticoagulants are prescribed for prophylactic purposes to prevent heart disease. Unstable angina, abnormal heart rhythm, valve defects - all these diseases can be prevented or minimized if you regularly take medications belonging to the group of oral anticoagulants.

Antithrombotic drugs and their action

There is another direction for the use of anticoagulants - stabilization of blood composition before laboratory tests or transfusion. Based on their action, drugs are divided into 2 types: direct anticoagulants and indirect ones.

What are direct acting coagulants? Heparins are topical drugs that are characterized by minimal permeability and weak effect. Drugs in this group are prescribed for the treatment of varicose veins, hemorrhoids or for the rapid resorption of hematomas. The group of topical heparins includes:

Lyoton;
Venitan
Laventum.

Their prices vary, so everyone can choose the most suitable option for themselves. There are heparins intended for injection. The mechanism of action of these drugs is based on the inhibition of various blood clotting factors. Drugs in this group can be administered subcutaneously or intravenously.

They quickly begin to interact with blood cells, their activity remains for 24 hours.

Direct acting antithrombotics are used to eliminate thrombin. This group includes the following medications: Desirudin, Lepirudin, Bivalirudin, Melagatran, Argatroban, Dabigatran, Ximelagatran. They have a high rate of effectiveness in the treatment and prevention of strokes. Serious disruptions in liver function are possible only with long-term use of the drug. The action of sodium hydrocytart is based on the preservation of blood components, so the medicine is used as a blood preservative in laboratory studies.

Indirect acting compounds

The action of drugs in this group is aimed at reducing the formation of proteins, they eliminate the occurrence of prothrombin in the liver. The most popular drug in this group is Warfarin. It is produced in tablets of 2.3.5 mg. The maximum therapeutic effect is achieved after 5 days from the start of taking the medicine. Indications for use are thrombosis and thromboembolism. It is important to note a number of possible side effects: nausea, vomiting, disruption of the gastrointestinal tract, itching, eczema, possible hair loss, and the development of urolithiasis. Warfarin is strictly prohibited for use in cases of severe kidney and liver diseases, acute bleeding, predisposition to esophageal veins, hemorrhoids, and during pregnancy.

It is important to know which foods can be consumed while taking Warfarin, and which should be excluded from the menu. Garlic, sage, papaya, onion, cabbage, cucumber, mint, spinach, parsley, peas, turnips, olive oil, cilantro, pistachios, and alcohol should be removed from the diet. For those taking indirect anticoagulants, the following measures are important:

accurately calculate your vitamin K intake every day;
monitor INR;
Monitor symptoms of possible internal bleeding so that if it occurs, you can see a doctor as quickly as possible.

New generation medicines

Every year, specialists carry out developments to improve the quality and effectiveness of oral anticoagulants. Modern drugs are distinguished by a minimal list of contraindications for use and side effects, as well as the absence of the need to monitor blood clotting parameters.

The mechanism of action of the new generation of drugs is somewhat different from the old-style analogues. Managed to achieve:

minimizing control over blood clotting parameters;
lack of constant adjustment of the drug dose;
expanding the list of patients for whom anticoagulant use was previously contraindicated;
taking 1 anticoagulant to treat various diseases;
possibilities of treating children with this type of medicine.

Despite all the achievements of the developers, the new generation of drugs is not perfect and has its pros and cons. The positive points include:

fast action of the medicine;
minimal influence of nutrients and other drugs when used simultaneously with an anticoagulant;
safety of use.

Negative points include:

unlike old-style drugs, new generation anticoagulants should be taken strictly according to the prescribed schedule, without omissions or changes;
inability to conduct tests and monitor the therapy performed during emergency cessation of treatment;
a number of side effects that were previously absent from older generation drugs;
high risk of gastrointestinal bleeding;
high cost of drugs.