Anticoagulants

Coagulation is the process of blood clotting and forming solid masses. The process of coagulation is initiated by platelets in blood. When coagulation occurs in blood vessels, it is called thrombosis. Though it is a natural process, clotting of blood causes certain health complications like kidney failure, deep vein thrombosis, pulmonary embolism, heart attack, stroke, and others. An anticoagulant is a blood thinner that can reduce the property of blood to form clots. These medications are generally consumed orally and have antithrombotic properties. Some of these anticoagulants are also administered in the intravenous route when a patient is hospitalized. Anticoagulants are used for the same purpose as antiplatelet medications, but they act different. They are prescribed to people who are at a risk of getting a heart attack or a stroke. These class of medications work by breaking the process of forming blood clots and by thinning blood. Warfarin (Coumarin group) is a commonly prescribed anticoagulant. Its method of action is to inhibit and block Vitamin K, which is responsible for activating the process of blood clotting. When Vitamin K epoxide reductase is blocked, clotting ability of blood is reduced and thus the risk of a blockage is avoided. This medication is also effective for preventing blood clots in veins. Another anticoagulant medication group that is widely used is Factor Xa inhibitor. Factor Xa present in blood is a major contributor in the coagulation cascade pathways. Factor Xa inhibitors act by selectively and reversibly blocking the process of clotting in blood and in the existing clot. This group of medications is effective for people who have undergone surgeries like knee & hip replacement, for prevention of pulmonary embolism, thromboembolism in atrial fibrillation, in deep vein thrombosis, and for people who are at a risk of heart attack. Heparins are a group of anticoagulants that can be injected. These come in two types – low molecular weight and high molecular weight heparins. These are given to high risk patients who are prone to develop blood clots and develop deep vein thrombosis, heart attack, and other conditions. These are also given to hospitalized patients. These group of medications act by blocking factor Xa and antithrombin III. Thrombin inhibitors are another class of anticoagulants that reduce the risk of blood clotting by inhibiting the action of thrombin. Since thrombin plays a vital role in the coagulation cascade pathways, inhibiting it reduces blood clot formation. These class of drugs are given as prophylactics in patients to avert angina, pulmonary embolism, and atrial fibrillation. Side effects of anticoagulants include dark colored urine due to urinary tract bleeding, dark colored stools due to intestinal bleeding, more bleeding than usual, bleeding gums, weakness, dizziness, headache, and stomachache. People with diabetes are at a higher risk of developing thrombosis and inflammation. This means that they are at a higher risk of having blood clots. Prolonged periods of high blood sugar levels, insulin resistance, and damage to blood vessels lead to many cellular level. People with diabetes are known to exhibit excessive activation of platelets and factors of blood clotting along with coagulation markers. Also, there is a decreased anticoagulant mechanism in blood. This places them in a high-risk group of stroke, heart attack, deep vein thrombosis, pulmonary embolism and many other macro and microvascular complications. People with diabetes are prone to get atrial fibrillation. Since anticoagulant medication can increase the risk of bleeding, it is important to adjust the dosage properly. These medications might also need some changes in the diet as some vegetable oils and legumes as they contain vitamin K and consumption of ginger, garlic, and gingko biloba improves the action of the medication.