What is an anticoagulant, and when is it prescribed?

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Anticoagulants are a family of medications that stop your blood from clotting too easily. They can break down existing clots or prevent clots from forming in the first place. These medications can help stop life-threatening conditions like stroke (brain damage due to the blockage of the blood supply), heart attacks, and pulmonary embolism (a blood clot that blocks the blood vessels of the lung), all of which can happen because of blood clots.

When blood clots work like they are supposed to, they form at the site of an injury that needs repair, and they stay put. However, when clots do not stay in one place or form in your bloodstream, they can be extremely dangerous. If a clot is too large, it can get stuck in a smaller blood vessel. If that smaller blood vessel is in a critical location, it can block the blood flow that one of your organs needs to survive.

Blockages from blood clots can cause the following deadly events:

1. Stroke. Blood clots are particularly dangerous if they travel up to your brain, where they can easily get stuck in the smaller blood vessels.

2. Pulmonary embolism (PE) occurs when a blood clot gets stuck and blocks an artery in your lungs. If the blockage is severe enough, a pulmonary embolism can be deadly.

3. Heart attack (myocardial infarction) occur when the arteries that supply blood to your heart become blocked. These can also be deadly.

Anticoagulants are extremely effective in preventing life-threatening conditions like stroke, pulmonary embolism, and heart attack. There are also several different ways that these medications work. That means people who cannot take one medication may still be able to take a similar medication.

1. Warfarin has a much higher risk of causing bleeding because the dosage must be precise. Other risks and side effects include:

• Skin necrosis is a rare complication where warfarin causes clots to form in the blood vessels in your arms and legs or surface fatty tissue like breasts, buttocks, or thighs. Those clots block blood flow, causing the affected areas of the skin to die. This is most often seen in people who have deficiencies in certain blood proteins.
• Blue or purple toe is a color change in your toes and feet, especially on the soles of your feet or the sides of your toes. The condition is sometimes painful and usually happens anywhere from a few weeks to two months after you start taking warfarin.
• Congenital disabilities or miscarriages: Warfarin can damage an embryo or fetus, so it should not be taken during pregnancy. However, warfarin is safe when breastfeeding because it can’t be passed through breast milk.

2. Heparin can affect other components of your blood and your bones, with side effects ranging from mild to severe.

• Type I: This type of HIT (heparin-induced thrombocytopenia) causes a slight decrease in platelets, a type of blood cell that is instrumental in the blood's ability to clot. This type of HIT is more common and happens to about 10 percent of the people on heparin or its variants. It's not considered dangerous, and it usually goes away within a week after you are no longer receiving heparin.
• Current or recent trauma or bleeding.
• Recent major surgery.
• History of bleeding in the brain, including stroke or aneurysm.
• End-stage liver disease.
• Certain conditions that affect blood clotting.

3. Direct oral anticoagulants

• Apixaban: Pregnancy.

• Betrixaban: Pregnancy.

• Dabigatran: Severe kidney or liver problems.

• Edoxaban: Severe kidney problems.

• Rivaroxaban: Severe kidney problems.

I hope this helps.

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Thank you.