Choosing the Right Anticoagulant For You

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One of the most common classes of medications used in the treatment and management of heart or blood vessel disease are anticoagulants. Anticoagulants are recommended in particular to patients experiencing atrial fibrillation, an irregularity in the heartbeat that increases the risk of blood clots forming in the chambers of the heart. Choosing the Right Anticoagulant For You
According to the American Heart Association, more than 2.7 million Americans suffer from atrial fibrillation. The majority of these are treated with anticoagulants. These medications eliminate or reduce the formation of dangerous blood clots in the arteries and are often known colloquially as “blood thinners”. Although anticoagulants do not actually thin blood, they do break up clots that may form in the brain, blood vessels, or heart by interfering with the proteins in the blood that are involved in coagulation. Everyone has clotting factors in their blood to ensure that if they are injured or cut that they do not bleed to death. However, when cardiovascular conditions like hypertension or atherosclerosis present, dangerous blood clots can form that may block the flow of blood to the heart or the brain, increasing the risk of stroke and heart attack. The formation of these dangerous clots is called thrombosis, a condition that can be managed with the correct administration of anticoagulant medication. Choosing the Right Anticoagulant For You

The most popular anticoagulant on the market is warfarin. Warfarin inhibits the action of vitamin K, which assists in the production of proteins that contribute to coagulation. Since the 1950’s this drug has been used to reduce the risk of thrombosis, thereby reducing the risk of heart attack and stroke. Although it is highly effective, warfarin – which is sold under the brand name Coumadin – is known to interact with certain foods and medications or supplements.
These interactions can affect warfarin’s therapeutic effect and may lead to bleeding or increased risk of dangerous blood clots, thereby necessitating very close monitoring of the patient’s clotting factors. Many patients on warfarin may require certain dietary restrictions in order maintain a balanced dosage, and contraindicated drugs may either enhance or limit anticoagulant effects. A weak dosage can carry increased risk of stroke and heart attack while an excessive dosage can cause serious internal bleeding. Choosing the Right Anticoagulant For You

Patients must undergo regular blood tests called international normalized ratio (INR) tests that evaluate coagulation, liver function, and vitamin K levels. The results of these regular tests help doctors determine the correct dosage of warfarin while protecting the patient from potentially harmful side-effects and interactions. Although warfarin is not easy to manage and requires constant monitoring, an experienced and attentive physician will be able to successfully administer the medication.
One important benefit of warfarin is that it although it has a limited window of efficacy, its anticoagulant effects are easily reversible. Vitamin K is one antidote to warfarin that will hasten the reversal of the anticoagulant effect and allow blood to clot more rapidly if the patient needs to undergo surgery or has been injured.

For more than 60 years, warfarin has been the primary course of treatment for patients with heart and blood vessel disease, however recently a new class of anticoagulant medications was approved for use in the United States. The development of these novel oral anticoagulants, also known as NOACs or non-vitamin K antagonist anticoagulants, has been regarded as a tremendous advance in the field of cardiovascular care.
Compared to warfarin, NOACs have few interactions with foods or other prescription drugs and their effects last longer and are more predictable. These two benefits mean that there is no need for consistent monitoring and patients do not need to undergo frequent blood tests. This places much less demand on patients.

NOACs do have one drawback: while warfarin is easily reversible in case of anticoagulant-related complications, serious injury, or emergency surgery, NOACs take longer to reverse and do not have a specific antidote.
Prior to surgery, it is recommended that patients refrain from taking their medication for 24-48 hours prior. While there are currently antidotes in the advanced development stage, these are not yet available in a clinical setting. Nonetheless, the ease of adherence to NOACs in comparison to warfarin means that the drugs may be more suitable for patients with limited mobility who are unable to travel for frequent blood tests.
Another consideration when comparing warfarin and NOACs is cost. Warfarin is readily available and very inexpensive while popular NOACs are significantly more expensive – while Coumadin is about 10$ for thirty pills, available NOACs cost about 350$ for the same amount. However, with NOACs achieving widespread inclusion in most prescription insurance programs and Medicare, this high price may not translate to high out of pocket costs. Furthermore, the need for constant monitoring with warfarin should be factored as part of the total cost of this course of treatment.

When choosing between treatment alternatives in anticoagulant drug therapy, a number of factors need to be taken into consideration.

What are the relative benefits and drawbacks of each course of treatment and how can one decide between them?
The simple answer is that it depends on each individual patient’s needs. Making medical decisions can be challenging and it is important for patients to have an advocate working on their behalf.

As a cardiologist in practice for more than three decades, I have made it my life’s mission to treat every patient as though they are my only patient. Choosing the Right Anticoagulant For You
When deciding between two competing courses of action, it is easy to feel overwhelmed. A good doctor is not just there to dictate his preferred choice, but to explain the relative benefits of either one and assist the patient in making the best decision for their circumstances.
At my practice, the patient is always our first priority.
Whether choosing the appropriate anticoagulant or making any other medical decision, at Dr. Leonard Pianko’s Aventura Cardiovascular Center, our entire staff is invested in offering the best care for each individual patient.
From the desk of Dr. Leonard Pianko, MD PA FACC
Dr. Leonard Pianko, the founder of the Aventura Cardiovascular Center, is board certified in cardiology and internal medicine with special expertise in cardiovascular disease, preventive cardiology, and non-invasive treatment options, including echocardiogram and nuclear stress testing. A native of New York, Dr. Leonard Pianko, M.D., F.A.C.C., was born in the Bronx, and earned an undergraduate degree from Yeshiva University in New York before receiving his medical education at top-ranked Mount Sinai School of Medicine and completing his training at the prestigious Robert Wood Johnson School of Medicine in New Brunswick, New Jersey. For more information about this blog contact Dr. Pianko at http://www.leonardpiankomd.com/contact.php.