Anticoagulants are drugs that work to prevent blood clots. This drug works by inhibiting the action of a protein involved in the blood clotting process.
Anticoagulant drugs are often referred to as blood thinning drugs, but this designation is inaccurate. Anticoagulant drugs do not thin the blood, but increase the time it takes for the blood to clot.
The process of blood clotting plays an important role in stopping bleeding if an injury occurs. However, blood that clots and clots in the brain, heart, or lungs is actually dangerous because it can block or stop blood flow to these organs.
Anticoagulant drugs are used to treat and prevent blockage of blood vessels, such as in the following conditions:
- atrial fibrillation
- Heart attack
- Congenital heart disease
- strokes and transient ischemic attack (TIA)
- Deep vein thrombosis (DVT)
- Pulmonary embolism
In addition to a number of diseases above, anticoagulant drugs are also used in patients who are at risk of developing blood clots due to the following conditions:
- Recently had knee or hip replacement surgery
- Undergo heart valve replacement surgery
- Suffering from thrombophilia and antiphospholipid syndrome
- Have a previous history of blood clots
Types of Anticoagulants
Anticoagulants are divided into four groups. This division is based on its function in inhibiting the function of proteins that play a role in the blood clotting process. The four groups are:
- Warfarin, which is a type of coumarin anticoagulant drug that works by blocking the action of vitamin K in the blood
- Factor Xa inhibitors, which are a type of anticoagulant drug that works by inhibiting the action of factor Xa
- Thrombin inhibitors are a class of anticoagulant drugs that prevent thrombin activation
- Heparin, which is a type of anticoagulant drug that plays a role in inhibiting thrombin and factor Xa
Precautions Before Using Anticoagulants:
- Do not use anticoagulant drugs if you have a cerebral aneurysm, endocarditis, pericarditis, aortic dissection, pericardial effusion, or are at high risk of stroke
- Do not consume alcoholic beverages while on anticoagulant treatment as this can increase the risk of bleeding.
- While using anticoagulant drugs, it is recommended to undergo regular blood tests. Blood tests aim to adjust the dose, and ensure the effectiveness and safety of using anticoagulant drugs.
- Consult your doctor first if you need anticoagulants while pregnant or breastfeeding. The doctor will prescribe the appropriate type of anticoagulant.
- Before using anticoagulant drugs, tell your doctor if you have kidney disease, liver disease, blood clotting disorders, high blood pressure, heart failure, or balance disorders.
- Tell your doctor if you are taking anticoagulant drugs before undergoing surgery or other diagnostic and treatment procedures. Treatment with anticoagulants may be discontinued for some time.
- Before using anticoagulant drugs, first consult with your doctor regarding foods, beverages, drugs or supplements that can affect the performance of anticoagulants.
- Discuss with the pediatrician about the use of anticoagulant drugs in children, so that they can be given the right type of drug and dose.
Side Effects and Dangers of Anticoagulants
Bleeding is the most likely side effect of using anticoagulant drugs. Some complaints that can indicate bleeding are:
- Nosebleeds that often repeat and stop for a long time
- Easy bruising
- Bleeding gums
- Black stool
- Vomiting blood or coughing up blood
- Excessive menstruation in women
- Severe back pain that appears suddenly
- There is blood in the urine and feces
Other side effects that may arise due to the use of anticoagulant drugs depend on the type of anticoagulant used, including:
- Nauseous
- Itchy skin
- Loss of appetite
- Diarrhea or constipation
- Hair loss
- Headache
- Burning feeling in chest (heartburn)
- Yellowing of the skin and whites of the eyes (jaundice)
- Pain and irritation at the injection site
- Hard to breathe
- Chest pain
Type, Trademark and Dosage of Anticoagulants
The dose of anticoagulant depends on the type and form of the drug, as well as the age and condition of the patient.
warfarin
Dosage form: tablet
Trademarks: Warfarin, Simarc, Rheoxen, Notisil
- Condition: treatment and prevention deep vein thrombosis (DVT)
Adults: initial dose is 5–10 mg, once daily. Maintenance dose 3–9 mg per day.
Fondafarinux
Fondafarinux dosage form: subcutaneous injection (under the skin/SC)
Trademark: Arixtra
- Condition: external venous thrombosis
Adult: 2.5 mg, once daily, for 30–45 days.
- Condition: deep vein thrombosis (DVT)
Adults: 5–10 mg, once daily, for 5–9 days. Dosage is adjusted according to body weight.
- Condition: prevention of complications of DVT in abdominal and orthopedic surgery
Adult: 2.5 mg, once daily, started 6–8 hours after surgery. Injections can be continued for up to 5–32 days.
Rivaroxaban
Dosage form of rivaroxaban: tablets
Trademark: Xarelto
- Condition: treatment of DVT and pulmonary embolism
Adult: initial dose 15 mg, 2 times daily, for 3 weeks. The maintenance dose for the treatment and prevention of recurrence of the disease is 20 mg, once daily.
- Condition: prevention of complications of DVT due to surgery
Adult: 10 mg, once daily, started 6–10 hours after surgery. Treatment is continued for 2–5 weeks after hip and knee replacement surgery.
- Condition: prevention of heart and blood vessel disease
Adults: 2.5 mg, 2 times daily.
Apixaban
Apixaban dosage form: tablets
Trademark: Eliquis
- Condition: treatment of DVT and pulmonary embolism
Adult: initial dose 10 mg, 2 times daily, for 7 days; followed by 5 mg, 2 times daily. After undergoing treatment for at least 6 months, take apixaban 2.5 mg, 2 times daily, to prevent recurrence.
- Condition: prevention of complications of DVT due to surgery
Adult: 2.5 mg, 2 times daily, started 12–24 hours after surgery. Treatment is continued for 10–38 days after surgery.
- Condition: prevention of stroke and embolism due to heart rhythm disturbance
Adults: 5 mg, 2 times daily
Heparin
Dosage forms: subcutaneous (under the skin/SC) and intravenous (intravenous/IV) injections
Trademarks: Hepagusan, Heparinol, Hico, Inviclot, Oparin, Thromboflash, Thrombogel, Thrombophob, Thromecon
- Condition: prevention of complications of DVT due to surgery
Adult: 5,000 units (U) by CS, given 2 hours before surgery, then every 8–12 hours, for 7 days or until the patient is immobile.
- Conditions: peripheral arterial embolism, pulmonary embolism, angina, DVT
Adult: 75–80 U/kg or 5,000–10,000 U, followed by 18 U/kg or 1,000–2,000 U per hour by intravenous infusion.
Children: 50 U/kg, followed by 15–25 U/kg per hour.
- Condition: DVT
Adult: 15,000–20,000 U SC, every 12 hours, or 8,000–10,000 U every 8 hours.
Children: 250 U/kgBW, 2 times a day
Enoxaparin
Dosage forms of enoxaparin: subcutaneous (under the skin/SC) and intravenous (intravenous/IV) injections
Trademark: Lovenox
- Condition: STEMI heart attack (ST-elevation myocardial infarction)
Adult: 30 mg IV and 1 mg/kg by SC. After that, continued with a dose of 1 mg/kgBW by SC, for 8 days or until hospitalization is complete. The initial two SC injections should not exceed 100 mg.
In patients undergoing cardiac ring insertion, the dose will be increased by 300 mcg/kgBW IV if the last SC injection has been more than 8 hours.
Elderly 75 years: 750 mcg/kg every 12 hours. The maximum dose is 75 mg in the first 2 injections.
- Condition: unstable angina
Adult: 1 mg/kg by SC, every 12 hours, for 2–8 days.
- Condition: prevention of DVT during surgery
Adult: 20–40 mg, once daily, for 7–10 days. The first dose is given 2–10 hours before surgery. In patients undergoing hip replacement surgery, treatment is continued at a dose of 40 mg, once daily, for up to 3 weeks after surgery.
Children: 500–750 mcg/kg by SC, every 12 hours.
- Condition: DVT pengobatan treatment
Adult: 1 mg/kg by SC, every 12 hours; or 1.5 mg/kg, once daily, for up to 5 days.
Children: 1–1.5 mg/kg, by SC, every 12 hours.
- Condition: prevention of blood clots during dialysis
Adults: 1 mg/kg body weight injected through the arterial tube leading to the machine at the start of the dialysis procedure.
Nadroparin
Dosage forms: injections subcutaneously (under the skin/SC) and intravenously (via a vein/IV).
Trademark: Fraxiparine
- Condition: heart attack/unstable angina
Adults: 86 units/kg by SC, 2 times daily, for 6 days. The first dose can be given IV.
- Condition: prevention of complications of DVT due to surgery
Adult: For moderate risk patients, 2,850 units by CS, once daily, for 7 days or until patient is immobile. The first injection is given 2–4 hours before surgery.
For high-risk patients, 38–57 units/kg, once daily, given 12 hours before surgery, 12 hours after surgery, and continued for up to 10 days.
- Condition: DVT pengobatan treatment
Adults: 85 units/kg by SC, 2 times a day; or 171 units/kg, once daily.
- Condition: prevention of blood clots during dialysis
Adults: 2,850 U (BW < 50kg), 3,800 U (BW 50–69 kg), or 5,700 U (BW 70 kg) injected through the arterial tube that goes to the machine when dialysis is started.
Parnaparin
The dosage form of parnaparin is a subcutaneous (under the skin/SC) injection.
Trademark: Fluxum
- Condition: prevention of complications of DVT due to surgery
Adults: 3,200–4,250 units (U), given 12–2 hours before surgery to 7–10 days after surgery.
- Condition: DVT pengobatan treatment
6,400 U, for 7–10 days.
Dabigatran
Tablet dosage form
Trademark: Pradaxa
- Condition: prevention of DVT after surgery
Adults: initial dose of 110 mg given 1–4 hours after surgery, followed by 220 mg, once daily, the following day for up to 10–35 days.
Elderly 75 years: initial dose of 75 mg given 1–4 hours after surgery, followed by 150 mg, once daily, on the following day for 10–35 days.
- Condition: prevention of stroke and other embolic diseases due to heart rhythm disturbances.
Adults: 150 mg, 2 times daily.
Elderly 75-80 years: 110–150 mg, 2 times daily.
To get a more detailed explanation of each type of anticoagulant drug above, please visit the A-Z drug page.