what is an anticoagulant

8/2/2019 What is an Anticoagulant

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What is an anticoagulant?

An anticoagulant is a drug that helps prevent theclotting (coagulation) of blood. These drugs tend toprevent new clots from forming or an existing clotfrom enlarging.

Anticoagulants are given to people to stop thrombosis(blood clotting inappropriately in the blood vessels). Thisis useful in primary and secondary prevention of deepvein thrombosis, pulmonary embolism, myocardial

infarctions and strokes in those who are predisposed.

Heparin and warfarin, a derivative of coumarin, aresome examples of anticoagulants.


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Which are the

contraindications? Individual hypersensitivity towards the

product or to any component of the

preparation, heparin or heparin-likeproducts. Diathesis and haemorrhagic

diseases.


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Special warnings?

When treatment with anticoagulants is under way,

haemocoagulative parameters should be monitored

periodically

(This warning is given as a precaution: in reality,periodical tests have to be carried out to monitor the

safety profile of the concomitant anticoaugulant drug).

In fact only SULODEXIDE by i.v. route could add

systemic anticoagulant effects to the other drug


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What are the main

undesirable effects? Gastroenteric disorders with nausea, vomiting and

epigastralgias may occasionally occur when capsules

are administered. With ampoules, pain, burning sensation and

haematomas at the site of the injection have beenobserved. Rare case of sensitization may also occur withreaction in the skin or in other sites.


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Heparin Heparin, a highly-sulfated glycosaminoglycan, is widely used as an

injectable anticoagulant and has the highest negative charge densityof any known biological molecule.

Heparin acts as an anticoagulant, preventing the formation of clotsand extension of existing clots within the blood. While heparin doesnot break down clots that have already formed it allows the body'snatural clot lysis mechanisms to work normally to break down clotsthat have already formed.

Heparin is used for anticoagulation for the following conditions: Acute coronary syndrome, e.g., heart attack

Atrial fibrillation Deep-vein thrombosis and pulmonary embolism

Cardiopulmonary bypass for heart surgery.

ECMO circuit for extracorporeal life support


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Heparin

It can be injected intravenously or subcutaneously (under theskin). Intramuscular injections (into muscle) are avoidedbecause of the potential for forming hematomas.

Because of its short biologic half-life of approximately onehour, heparin must be given frequently or as a continuousinfusion.

However, the use of low molecular weight heparin (LMWH)has allowed once daily dosing, thus not requiring a continuous

infusion of the drug.

If long-term anticoagulation is required, heparin is often usedonly to commence anticoagulation therapy until the oralanticoagulant warfarin takes effect.


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LMWH In medicine, low-molecular-weight heparin (LMWH) is a class of

medication used as an anticoagulant in diseases that featurethrombosis, as well as for prophylaxis in situations that lead to ahigh risk of thrombosis

LMWHs are defined as heparin salts having an average molecularweight of less than 8000 Da and for which at least 60% of all chainshave a molecular weight less than 8000 Da.

These are obtained by various methods of fractionation ordepolymerisation of polymeric heparin.

Because it can be given subcutaneously and does not require APTTmonitoring, LMWH permits outpatient treatment of conditions suchas deep vein thrombosis or pulmonary embolism that previouslymandated inpatient hospitalization for unfractionated heparinadministration


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Brief introduction of the new DA

Front cover

As you can see from this shining brochure, Sulodexide

come with big shining red s. Do you know why? For one simple reason- Sulodexide is the super- vessel-

protector for the blood vessels of our body!

That why, Sulodexide is used in Global protection forthe endothelium

Let me share further with you, how super-vessel-protector Sulodexide plays a role in protecting theblood vessels of our body


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Page 1 & 2 GAGs are glycosaminoglycan. GAGs are major constituents

of vessel walls that maintain the biocompatibility andpermeability of endothelium

However, due to hyperglycemia condition, there are losses

of GAGs from the vessels. Sadly to say, it leads toendothelial dysfunction or vascular damage.

And we know the vascular damage will lead to vascularcomplications!Any delay to repair the vascular damagemeans paying a lot of money later for multiple organ

failure like heart, eyes, kidney and leg. On top of that,the mentally stresssuffer by patients and caregivermeaning they might need to change their life drasticallyin accommodating to various complications.


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Page 1 & 2

Knowing diabetes is a vascular disease. We can control allthe risk factors causing the vascular damage and hopeful wewould not progress to vascular complications. The question

is: what about the vascular damage happened earlier orhappening at this very moment?

This is where Sulodexide being a specific GAG is able torestore the integrity of the vessels walls and protect the

endothelium.


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Page 5 & 6

It is widely accepted albuminuria is marker of generalvascular damage. Thats why; CPG guideline and AmericanDiabetes Association recommend yearly microalbuminuriascreening is a must for all diabetes patients. We know by

lowering the albuminuria we also reducing the risk of cardiovascular and renal disease. We know for a fact microalbuminuriaincreases the Cardio vascular disease two-folds!

Sulodexide being a super-vessel-protector for the bloodvessel, offers global cardiovascular protection as seen in IPO-V2

study in 3986 post MI patients. The outcome of the IPO-V2 is 32%in mortality rate, 28% in reinfarction rate and 53% in LVthrombus formation.


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Page 5 & 6

In addition, Sulodexide is effective in doubling the painfree walking distance and maximum walking distance.

In diabetes retinopathy, improvement or stabilizationof hard exudates is seen in 88% of patients treated withSulodexide.

All these studies clearly showed the proven benefits

of Sulodexide in preserving the micro andmacrovascular functions of our blood vessels


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Page 3 & 4

The benefit of Sulodexide is also seen in kidney whereSulodexide is able to lower albuminuria excretion rate upto 74% with Sulodexide 200mg in 4 months. Importantly,the albuminuria lowering is long lasting even after 4monthsstopping Sulodexide. This is not seen in other

medication. E.g. BP will rise once we stop the BPcontrolling medication.

The DINAS trial by Dr Gambaro concluded the long lastingeffect is due to structural changes ofGBM and vascular.This clearly shown the effectiveness of Sulodexide in

repairing the vascular damage! By delaying the vasculardamage will helps in delaying the progression of diabeticnephropathy. Do you agree with me?


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Page 3 & 4 Another interesting finding from DINAS is reduction of albuminuria is

also seen even in ACE-Inhibitor patients. Sulodexide has its ownimportant role to play which is restoring the integrity of vesselsand repairing the vascular damage caused by loss of GAGs.That is why Sulodexide should be used earlier during the onsetof microalbuminuria and not during the complications.

For your diabetes patients withmicroalbuminuria, dont deprivethem the benefit of super vessel protector in addressing thevascular damage before the complications set in!We knowpatients life will never be the same any moreif they need togo 3 times a week for dialysis, not able to go traveling due to

PAOD and living in depress and sick.

Dr Lee, I strongly urge Dr Lee to consider Sulodexide for 2-3 of yourpatients with at least 4 months treatment for a start?


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antiplatelet drug An antiplatelet drug is a member of a class of

pharmaceuticals that decreases platelet aggregation andinhibits thrombus formation. They are effective in thearterial circulation, where anticoagulants have littleeffect.

They are widely used in primary and secondaryprevention of thrombotic cerebrovascular orcardiovascular disease.

The most important antiplatelet drugs are:

Aspirin

Clopidogrel (Plavix)

Ticlopidine (Ticlid)


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anticoagulant An anticoagulant is a substance that prevents

coagulation; that is, it stops blood from clotting.

A group of pharmaceuticals called anticoagulants can beused in vivo as a medication for thrombotic disorders.

Some chemical compounds are used in medicalequipment, such as test tubes, blood transfusion bags,and renal dialysis equipment.

Anticoagulants are given to people to stop thrombosis(blood clotting inappropriately in the blood vessels). Thisis useful in primary and secondary prevention of deepvein thrombosis, pulmonary embolism, myocardialinfarctions and strokes in those who are predisposed.


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Coumarines (Vitamin K antagonists)

The oral anticoagulants are a class ofpharmaceuticals that act by antagonizing theeffects ofvitamin K. Examples include warfarin. It is important to note that it takes atleast 48 to 72 hours for the anticoagulant effect to develop fully. In cases when anyimmediate effect is required, heparin must be given concomitantly. Generally, theseanticoagulants are used to treat patients with deep-vein thrombosis (DVT), pulmonaryembolism (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.)

[edit] Available agents

Warfarin (Coumadin) This is the main agent used in the U.S. andUK[2]

Acenocoumarol and phenprocoumon This is usedmore commonly outside the U.S.and the UK

Brodifacoum Rat poison, not usedmedically

Phenindione

anticoagulant


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[edit] Heparin and derivative substances

Heparin is a biological substance, usually made from pig intestines. It worksby activating antithrombin III, which blocks thrombin from clotting blood.Heparin can be used in vivo (by injection), and also in vitro to prevent bloodor plasma clotting in or on medical devices. Vacutainer brand test tubes

containing heparin are usually colored green. [edit] Low molecular weight heparin

Low molecular weight heparin is a more highly processed product that isuseful as it does not require monitoring of theAPTT coagulation parameter(it has more predictable plasma levels) and has fewer side effects.

[edit] Synthetic pentasaccharide inhibitors offactor Xa

Fondaparinux is a synthetic sugar composed of the five sugars

(pentasaccharide) in heparin that bind to antithrombin. It is a smallermolecule than low molecular weight heparin.

Idraparinux

anticoagulant

what is an anticoagulant

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