Anticoagulants are a pharmacological group that prevents the formation of clots or thrombi within the circulatory system, delaying the proper and physiological clotting mechanism. Under normal conditions, it is not necessary to provide anticoagulants, because physiologically they are not necessary.
However, anticoagulant treatment is necessary in patients who are at high risk of thrombosis due to certain diseases of cardiac origin and suffer stroke, cerebral infarction or embolism as a complication.
Atrial fibrillation, the main cause of clot formation
Pathological coagulation or thrombosis of the circulatory system is mainly caused by atrial fibrillation, which is the most common arrhythmia. The prevalence of atrial fibrillation is around 4-5% in the population over 40 years of age, but reaches 10-15% at older ages.
The main problem is that this arrhythmia increases the risk of stroke and, therefore, anticoagulant treatment must be initiated. However, not all patients with atrial fibrillation should be anticoagulated. To indicate anticoagulant treatment, a risk scale is used to assess the risks that the patient may suffer depending on his or her state of health (if he or she is hypertensive, if he or she is diabetic, etc.).
This risk scale is what establishes the indication to anticoagulate or not. Usually, young people with atrial fibrillation do not need to be anticoagulated. On the other hand, older people, especially if they are women, should be anticoagulated, because the risk of embolism due to atrial fibrillation in women is greater.
And we anticoagulate more and more, because atrial fibrillation appears with age. As we live longer, the probability of having atrial fibrillation is greater and, therefore, the need to be anticoagulated is also greater. It is a very frequent reason for consultation in cardiology.
New anticoagulants: advantages over traditional anticoagulants
Previously, the most common anticoagulant treatment was the famous synthrom, but in recent years new anticoagulants have become available that have advantages over traditional anticoagulants in terms of administration and interactions with food or drugs.
On the one hand, synthrom has a very narrow therapeutic margin, so that a monthly analysis is mandatory to determine the dose. Thus, there are people who, depending on the month, may have different doses, so that the therapeutic level is adequate. However, with the new anticoagulants this is not necessary.
Currently, there are 4 new anticoagulants: two of them are administered in a single daily dose, while the other two are administered every twelve hours. None of them requires dose adjustment, except for age, renal function or weight, but once the dose is decided, it is the one that is maintained continuously, so that it is not necessary to make monthly analyses to determine another dose.
On the other hand, with synthroid it is usual to follow some precautions with foods that interfere with the levels, especially with greener vegetables or those containing vitamin K. Therefore, there are certain limitations in terms of taking certain foods, which is not the case with the new anticoagulants.
Another advantage is that drug interactions are lower than with synthrom, which generates some relief, especially when taking anti-inflammatory or other types of drugs.
The last advantage is that one of them, and then the other three, already have an antidote. The antidote is a drug that, in a few minutes, reverses the anticoagulant effect of the new anticoagulants. This is especially necessary when bleeding occurs due to anticoagulants or when urgent surgery is required in a patient who is anticoagulated.
Side effects of taking anticoagulants
The first problem with anticoagulants is the risk of bleeding. Anyone on anticoagulants is at risk of bleeding. Most hemorrhages are minor, so they are not life-threatening and do not usually leave sequelae. In some cases, as the most frequent bleeding is of digestive origin, it is necessary to perform a gastroscopy or colonoscopy, but these usually resolve.
A single stroke can result in death or severe neurological sequelae, so the decision to anticoagulate depends on the patient’s risk of embolism. If the risk of embolism is high, the protection provided by the anticoagulant outweighs the risk of hemorrhage, but if the risk of embolism is low, then anticoagulation should not be given, because the risk of hemorrhage outweighs the expected benefit of the anticoagulant. For this reason, specialists use a scale to decide which patients should be anticoagulated or not.
In any case, the risk of having an embolism depends on age, female sex, being diabetic, being hypertensive or having had a previous stroke. If these variables appear, the risk of embolism is important and therefore, anticoagulation is decided.