Blog « Horizon Vascular Specialists

Common Anti-coagulants

By Mihae Shin-Diep, NP on May 21st, 2015 in Medications,

You may have been placed on an anti-coagulant, also known as blood thinners, by your Horizon Vascular Surgeon or another physician. There are several medications that are commonly used to treat your vascular condition and we will provide a basic review of them here, including the pros and cons. If you have questions, please feel free to schedule an appointment with your vascular surgeon to discuss.

To note, anti-coagulants do not “thin the blood”, even though they are referred to as blood thinning medications. They work on a part of the body’s blood clotting mechanism to inhibit clotting. In other words, they interfere with the body’s normal clotting ability to help prevent new clots from forming.

Name	Pro	Con
Warfarin (Coumadin) Usual starting dose 10mg	Well studied Natural antidote Vitamin K can be administered if overdosed or bleeding Inexpensive	Narrow therapeutic window of INR 2-3 Frequent dosage changes and lab draws to keep INR between Affected by diet. Consistent, intake of Vitamin K ie. Monitor intake of green leafy vegetables, green vegetable Long half-life, takes 72 hours for dose adjustments to affect INR change
Enoxaparin (Lovenox) Usual dose 1mg/kg of weight	Shorter half-life of 4-7 hours. 1 or 2 doses can easily be held before surgery May be used during pregnancy	Administered by injection only Expensive but is covered by most insurances
Heparin Dosage adjusted by PTT level which varies on what the medication is being used to treat	Very short half-life of 1.5 hours Inexpensive	Administered intravenously only Frequent lab draws to keep PTT within therapeutic range
Rivaroxaban (Xarelto) Loading dose of 15mg twice daily x 21 days, then 20mg daily for duration of treatment	Ease of use No lab draws/ No levels to monitor Not affected by diet	No antidote Very expensive. Usually requires insurance pre-authorization Cannot use if history of kidney disease Black box warning- increased risk for clotting if stopped abruptly
Apixaban (Eliquis) Loading dose of 10mg twice daily for 7 days, then 5mg daily for duration of treatment	Ease of use No lab draws/ No levels to monitor Not affected by diet Less toxic on kidney, than Xarelto	No antidote Very expensive. Usually requires insurance pre-authorization Black box warning- increased risk for clotting if stopped abruptly

Finally, a word about aspirin and clopidogrel (Plavix):

They are not true anticoagulants, like the above medications, in that they do not interfere with the body’s ability to clot blood. They are anti-platelet medications which reduces platelet activation. In other words, they help make blood less sticky. Aspirin and Plavix are used commonly in cardiac and vascular patients who have had recent endovascular procedures. They help keep stents open.

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