Anticoagulant used in W.B.Cs counting:
a- Sodium citrate
b- Ammonium oxalate
c- SPS
d- EDITA***
e- Heparin.
--------------------------
What is anticoagulation?
Clot formation is a complex mechanism that aims to prevent bleeding after damage. However, sometimes the formation of clots can trigger a myocardial infarction, cerebral infarction, or formation of clots in the veins or within the atria of the heart, and in these cases, the administration of anticoagulant drugs is essential.
Anticoagulants, as its name suggests, are drugs that prevent blood clotting, thus preventing the formation of clots or preventing their growth and favoring their dissolution (disappearance) in case they have already been formed.
Drugs most used as anticoagulants:
Intravenous administration (unfractionated heparin) or subcutaneous heparins (low molecular weight heparins)
Heparins are drugs that act by indirectly inhibiting thrombin (clot formation) by binding to antithrombin, accelerating its mechanism of action. Unfractionated heparins (HNF) are intravenously administered and require strict control to avoid overdosing or underdosing.
Low molecular weight heparins (LMWH) arise as a result of chemical or enzymatic depolymerization (fractionation) of HNF, resulting in smaller molecules. Like HNF, they act on the same pathway to produce their anticoagulant effect; However, unlike these, they bind less to cells, are better absorbed subcutaneously and have less plasma protein binding, which only requires their administration 1 or 2 times a day and do not require laboratory control.
In cardiac pathology, these heparins (primarily enoxaparin or fondaparinux; low molecular weight heparins) are essential in the treatment of acute coronary syndrome (unstable angina or myocardial infarction). It is also essential during catheterization, to prevent clots from forming when catheters are introduced and brought into contact with blood, and when manipulating coronary arteries.
Sometimes, they are used in outpatients for the treatment of pathologies such as atrial fibrillation or venous thrombosis, almost always as bridge therapies until the prescription of oral anticoagulants.
Oral anticoagulants:
ACENOCUMAROL:
Especially acenocoumarol, better known as sintrom, although warfarin (aldocumar) is also available. These drugs act on vitamin K, necessary for the entire coagulation mechanism to function. They are used for the long-term prevention of various thromboembolic complications. In cardiology its most frequent use is in atrial fibrillation and in valvular heart disease (valve prostheses).
Since it is a drug that acts via vitamin K, it has great response variability, so strict control of the level of anticoagulation is always necessary.
DIRECT ACTION ANTICOAGULANS:
Direct-acting anticoagulants, which includes rivaroxaban, dabigatran, apixaban and edoxaban, are drugs that act differently than acenocoumarol and aldocumar, blocking the coagulation system at a certain point. This allows these drugs to be used at a fixed dose, once or twice a day, without the need to perform the usual hemostasis (or coagulation) controls performed with acenocoumarol, since blood drug concentrations are more predictable and stable.
It is vital that the patient be aware of the importance of taking these drugs correctly, filling in the prescribed dose and schedule. Misuse will increase the risk of having a stroke or bleeding.
a- Sodium citrate
b- Ammonium oxalate
c- SPS
d- EDITA***
e- Heparin.
--------------------------
What is anticoagulation?
Clot formation is a complex mechanism that aims to prevent bleeding after damage. However, sometimes the formation of clots can trigger a myocardial infarction, cerebral infarction, or formation of clots in the veins or within the atria of the heart, and in these cases, the administration of anticoagulant drugs is essential.
Anticoagulants, as its name suggests, are drugs that prevent blood clotting, thus preventing the formation of clots or preventing their growth and favoring their dissolution (disappearance) in case they have already been formed.
Drugs most used as anticoagulants:
Intravenous administration (unfractionated heparin) or subcutaneous heparins (low molecular weight heparins)
Heparins are drugs that act by indirectly inhibiting thrombin (clot formation) by binding to antithrombin, accelerating its mechanism of action. Unfractionated heparins (HNF) are intravenously administered and require strict control to avoid overdosing or underdosing.
Low molecular weight heparins (LMWH) arise as a result of chemical or enzymatic depolymerization (fractionation) of HNF, resulting in smaller molecules. Like HNF, they act on the same pathway to produce their anticoagulant effect; However, unlike these, they bind less to cells, are better absorbed subcutaneously and have less plasma protein binding, which only requires their administration 1 or 2 times a day and do not require laboratory control.
In cardiac pathology, these heparins (primarily enoxaparin or fondaparinux; low molecular weight heparins) are essential in the treatment of acute coronary syndrome (unstable angina or myocardial infarction). It is also essential during catheterization, to prevent clots from forming when catheters are introduced and brought into contact with blood, and when manipulating coronary arteries.
Sometimes, they are used in outpatients for the treatment of pathologies such as atrial fibrillation or venous thrombosis, almost always as bridge therapies until the prescription of oral anticoagulants.
Oral anticoagulants:
ACENOCUMAROL:
Especially acenocoumarol, better known as sintrom, although warfarin (aldocumar) is also available. These drugs act on vitamin K, necessary for the entire coagulation mechanism to function. They are used for the long-term prevention of various thromboembolic complications. In cardiology its most frequent use is in atrial fibrillation and in valvular heart disease (valve prostheses).
Since it is a drug that acts via vitamin K, it has great response variability, so strict control of the level of anticoagulation is always necessary.
DIRECT ACTION ANTICOAGULANS:
Direct-acting anticoagulants, which includes rivaroxaban, dabigatran, apixaban and edoxaban, are drugs that act differently than acenocoumarol and aldocumar, blocking the coagulation system at a certain point. This allows these drugs to be used at a fixed dose, once or twice a day, without the need to perform the usual hemostasis (or coagulation) controls performed with acenocoumarol, since blood drug concentrations are more predictable and stable.
It is vital that the patient be aware of the importance of taking these drugs correctly, filling in the prescribed dose and schedule. Misuse will increase the risk of having a stroke or bleeding.
Recommendations for anticoagulated patients:
- Always take the anticoagulant (Sintrom, Aldocumar, Xarelto, Pradaxa, Eliquis, Lixiana ...) at the same time, this way you will avoid forgetting.
- Take the exact dose that your doctor will give you for each day and never change the doses on your own without consulting.
- If one day you forget to take the dose at the usual time, but realize throughout the same day, take it as soon as possible. But if you do not remember until the next day, keep the dose you have, that is: do not vary on your own or take double, but tell your doctor about the forgetfulness.
- Acetylsalicylic acid (Aspirin®, Adiro®, Tromalyt®, AAS®, etc.), its derivatives (Solusprin®, Disgren®, etc.) and the medications that contain it (many anti-flu preparations) increase the effect of anticoagulants and the risk of bleeding.
- For the same reason (increased risk of bleeding), you should not take anti-inflammatories in general, as they interfere with treatment in an important way. Yes you can take for pain or fever: Metamizol (Nolotil) or Paracetamol (Termalgin, Gelocatil, etc).
- In any case, you should never take a new medicine or interrupt a treatment without first consulting.
- Deep injections are prohibited, for example, intramuscularly or intraarticularly.
- Avoid alcoholic drinks.
- In case of diseases that weaken you such as diarrhea, lack of appetite or other circumstances that require you to consult your doctor or go to the emergency department, you must inform and advance the control of anticoagulation.
- Communicate both the withdrawal and the start of other medications.
- Consult your hemostasis center or responsible doctor, one week in advance of any surgery, dental extraction or invasive exploratory tests (for example endoscopy, colonoscopy, biopsy).
- If you bleed from gums, nose, urine, bowel movements, or these are blackish or bruising spontaneously, you should tell the doctor responsible for anticoagulation.
- But if you bleed heavily you should go to the nearest emergency department.
- The appearance of severe headache and sudden onset or sudden onset of speech difficulties, loss of strength or vision disorders also require immediate medical evaluation.
- As soon as you suspect pregnancy, warn the doctor who controls your clotting.
Treatment with oral anticoagulants should always be carefully controlled. The dose is adjusted to each person after doing a blood test and various drugs (amiodarone, omeprazole, carbamazepine, NSAIDs, thyroxine, broad-spectrum antibiotics among others) or even the type of diet can have interactions (the effect of the anticoagulant is increases or decreases), hence frequent controls are necessary to adjust the dose.
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