A. Q: What are new thrombosis prevention drugs?
A: These drugs include: dabigatran (trade name: Tebigatran), rivaroxaban (trade name: Bactrim), apixaban (trade name: Eladol), and edoxaban (trade name: savaysa, Lixiana). These are all prescription medications that make your blood less likely to clog, also known as anticoagulants, blood thinners and antithrombotics.
Second, Q: What is the difference between these drugs and warfarin?
A: Warfarin (trade name: Coumadin) has been used for many years to prevent and treat blood clots. The newer drugs (dabigatran, rivaroxaban, apixaban, and edoxaban) work similarly to warfarin, but there are some differences.
People taking the newer drugs do not need regular blood tests to test for blood clotting or to adjust the dose of the drug. Warfarin users need weekly to monthly blood tests and sometimes warfarin dose adjustments
People taking the newer drugs do not have many dietary requirements. Those taking warfarin need to watch their intake of leafy greens and other vegetables and keep their daily intake consistent. These foods contain vitamin K, which can affect warfarin dosing.
Many of the newer drugs (dabigatran, apixaban, and sometimes rivaroxaban) may need to be taken twice daily, depending on the disease being treated. Edoxaban and warfarin only need to be taken once a day.
All antithrombotic drugs can cause bleeding. Some types of bleeding – such as bleeding in the brain – occur less frequently with the newer drugs than with warfarin.
Some of the newer drugs have no good way to counteract them, which means that if a patient is taking one of them and is prescribed a bleed, it can be difficult for doctors to stop it. If a person on warfarin has a bleed, there are many ways to control the bleed.
Warfarin is usually cheaper than newer antithrombotic drugs
There are more drugs than the newer drugs that can affect the effect of warfarin, but it is still important to tell your doctor what you are taking
Patients with mechanical valves (devices used to replace destroyed heart valves) need to take antithrombotic drugs. Warfarin is used in these patients. Newer antithrombotic drugs are not recommended for people with mechanical valves.
Some of the differences between different antithrombotic drugs are convenience or not, but some are very serious. Ask your doctor which drug is best for you.
Warfarin
Newer antithrombotic drugs (dabigatran, rivaroxaban, apixaban, edoxaban)
How many times a day should I take them?
Once a day
Once or twice a day, depending on the drug and the disease being treated
Do I need regular blood tests?
Yes
No
Take the same dose every day?
Possibly, but sometimes the dose may need to be adjusted to achieve the right dose. Also, you will need to adjust the dose when you start another medication or when you are sick.
Yes
If bleeding occurs, is there an antagonist?
Yes.
No, but these drugs clear faster than warfarin
How many drugs will change the action of the drug?
Many
Very little
Do I need to watch my diet while taking it?
Yes, you need to be careful about the amount of vitamin K you consume and also about foods that can interact with warfarin. Many doctors recommend limiting your daily intake of cranberry juice, grapefruit juice and alcohol to 1 or 2 servings or less
Very little – you need to avoid grapefruit and its juice, which can alter the effects of these drugs
How about price comparisons?
Cheaper
More expensive
Common differences between different types of antithrombotics
Q: Why should my doctor prescribe me an antithrombotic?
A: The primary reason doctors prescribe antithrombotics is to prevent or treat blood clots. There is nothing that can be done to completely prevent a blood clot, but such medications can reduce the risk of a blood clot.
These drugs do not relieve the clot, but they keep it from getting bigger and moving to other parts of the body.
Doctors prescribe antithrombotic drugs to prevent blood clots for patients who
patients with heart rhythm problems, called atrial fibrillation – for these patients, the drugs can help reduce the risk of stroke caused by blood clots
Patients with hip or knee replacements – these drugs help prevent blood clots in the legs (called deep vein thrombosis or DVT) or in the lungs (called pulmonary embolism or PE)
Doctors prescribe antithrombotic medications for the treatment of
Patients with blood clots in the legs or lungs
people who have had a stroke caused by atrial fibrillation
The goal is to reduce the chance of the clot growing or spreading and new clots forming.
If you need to take an antithrombotic, your doctor will do a blood test to check your kidney or liver function. If you have kidney disease, new anticoagulants may not be right for you.
Q: What do I need to do?
A: If you are taking a newer drug to prevent blood clots, you will need to do the following.
Know the dose of the antithrombotic, what the pill looks like, and why your doctor prescribed you this medication – usually in time before the medication is taken.
Take the medication as prescribed – It is important to take the medication as prescribed. Take it at the same time every day and do not miss a dose. Do not take twice the dose at once on your own, change the dose or stop taking the medication. Avoid consuming grapefruit or its juice while taking the medication because grapefruit can alter the effects of this type of medicine.
Store dabigatran in the bottle – do not put this in another container such as a pillbox or medicine box. After you open the bottle, take it within 4 months.
Do not break, chew, or open dabigatran capsules – this can change the strength of the medicine’s action. Take dabigatran with a full glass of water after a meal and do not lie down for half an hour after taking it; this reduces the chance of acid reflux or stomach upset.
Do not take pain-relieving medications such as ibuprofen, naproxen, or aspirin – if you need to take pain-relieving medications, ask your doctor which ones are safe. Acetaminophen (trade name: Tylenol) is usually safe.
Consult your doctor before taking new types of medications – this includes prescription, over-the-counter, and proprietary medications. Certain medications (especially antibiotics and St. John’s Wort) can alter the effects of newer medications
Wear a medication identification card – Always wear a bracelet, necklace or other identification card to remind people what you are taking the antithrombotic for. That way, if you have an accident and can’t account for your illness, people around you will know how to care for you. Your identification card should also have an emergency contact person and a contact number on it.
Q: What are the side effects of the new antithrombotic drugs that prevent blood clots?
A: The most common side effect is bleeding from any part of the body. The bleeding can be very little or sometimes severe. This also includes bleeding inside the body that you cannot see.
Call your doctor right away if you take an overdose or if you have any of the following signs that may be signs of bleeding.
upset stomach, vomiting blood or throwing up a coffee-colored substance
Headache, dizziness, or weakness
Nose bleeding or any bleeding that cannot be stopped
Solution of dark red or dark brown urine
Bleeding or darkening of the stool
Pain, swelling or dark, purple skin over an injury
You should also call your doctor if you experience any of the following.
Bleeding gums after brushing your teeth
Prolonged or heavy menstrual periods
Diarrhea, vomiting, or inability to eat for more than 24 hours
Fever (body temperature over 38°C)
Unable to take antithrombotic medication for some reason
Car accident or serious injury that may cause bleeding
VI. Q: Is there anything I can do to reduce the risk of bleeding?
A: You can reduce bleeding by doing the following.
Shaving with an electric razor instead of a razor
Use sharp tools, such as knives and scissors, carefully
Avoid doing things that could make you fall, such as walking on smooth surfaces or climbing on high stools
Avoid participating in physical activities where you could be injured
Always wear identification cards
Avoid taking over-the-counter medications that contain NSAIDs (such as ibuprofen or naproxen) unless you have consulted your doctor first
Avoid drinking too much alcohol, which increases the risk of bleeding
If you visit a new doctor, dentist, or nurse, let that person know what medications you are taking