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 studiedNatural antidote Vitamin K can be administered if overdosed or bleedingInexpensive | Narrow therapeutic window of INR 2-3Frequent dosage changes and lab draws to keep INR betweenAffected by diet. Consistent, intake of Vitamin K ie. Monitor intake of green leafy vegetables, green vegetableLong 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 surgeryMay be used during pregnancy | Administered by injection onlyExpensive 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 hoursInexpensive | Administered intravenously onlyFrequent 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 useNo lab draws/ No levels to monitorNot affected by diet | No antidoteVery expensive. Usually requires insurance pre-authorizationCannot use if history of kidney diseaseBlack 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 useNo lab draws/ No levels to monitorNot affected by dietLess toxic on kidney, than Xarelto | No antidoteVery expensive. Usually requires insurance pre-authorizationBlack 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.