Anticoagulants: most used and what they are for

Anticoagulants are drugs that prevent the formation of blood clots, because they block the action of substances that cause clotting. Clots are essential to heal wounds and stop bleeding, but there are situations in which they can prevent blood circulation, causing serious diseases, such as stroke, thrombosis and pulmonary embolism, for example.

Thus, anticoagulants allow blood to always remain liquid within the vessels and can circulate freely, being recommended for people who have suffered diseases caused by clots or who are at greater risk of developing them.

The most commonly used are Heparin, Warfarin and Xarelto, which need to be used carefully and always with medical supervision, because if their use is incorrect, there is a greater chance of developing severe bleeding.

Who should use

Anticoagulants should be used by people who are more likely to develop a thrombus, such as those with cardiac arrhythmias or who use heart valve prostheses. They are also used to eliminate a thrombus that has already formed, as in cases of people with thrombosis, pulmonary embolism or infarction.

Main types of anticoagulants

Anticoagulants can be divided according to the route of their use and their mode of action. They can be:

• Injectables, such as Heparin or Fondaparinux: they are injected directly into the vein or the region under the skin, and are more used in emergency situations, in the hospital, such as in cases of deep vein thrombosis, pulmonary embolism or myocardial infarction. Heparin can be used in pregnant women who had thrombosis, as they do not interfere with the baby's formation; Oral medications, such as Warfarin, Coumadin, Xarelto and Pradaxa: are tablets used at home, daily, to prevent the formation of clots or to dissolve clots that are preventing blood circulation.

The choice of the best anticoagulant pill and its dose should be made by the doctor, depending on the severity of the problem, history of diseases and the response of each person's body.

How to choose the best oral anticoagulant

There are different types of oral anticoagulants, and your choice will depend on considering their advantages and disadvantages for each person:

Types	Names	Benefits	Disadvantages
Vitamin K inhibitors	Warfarin (Marevan, Coumadin); Acenocoumarol (Sintrom).	- Very used; - Cheaper; - Allow greater control of coagulation through examinations.	- Need to do regular control of coagulation; - Doses need to be changed frequently, - Its effect can be altered by other medicines or foods rich in vitamin K.
New anticoagulants	Rivaroxaban (Xarelto); Dabigatran (Pradaxa); Apixabana (Eliquis).	- It is not necessary to make regular control of coagulation; - Single daily doses; - May have fewer side effects.	- More expensive; - Contraindicated in several diseases; - They have no antidotes.

In the case of vitamin K inhibitors, coagulation control should normally be done once a month or according to medical advice.

Natural anticoagulant remedies

There are some herbal substances popularly known as capable of "thinning" the blood and reducing the risk of clots, such as Ginkgo biloba or Dong quai, for example.

These plants can be used in teas or ingested in the form of capsules, sold in health food stores, however their use should never replace the drugs prescribed by the doctor, and should not be used in conjunction with other anticoagulants.

In addition, they should only be taken after the doctor's knowledge, as they can interfere with the action of other drugs, and, like coagulant drugs, these herbal medicines should be stopped in the preoperative period of any surgery.

Care during treatment

During treatment with anticoagulants it is important to:

• Report to the doctor whenever there are changes in the diet or in the use of medications so as not to deregulate the anticoagulant action; Never mix two types of anticoagulants, except in cases of medical indication; Watch for signs of bleeding, such as excessive stains on the skin, bleeding gums, blood in the urine or stool, and if any of them are present, seek medical attention.

Some foods rich in vitamin K reduce the action of certain anticoagulants, such as warfarin, and care should be taken in their consumption. However, as the dose of anticoagulant is adjustable to the needs of each person, it is not necessary to stop the consumption of all these foods, but rather to avoid a sudden change in diet, maintaining a constant amount in the diet.

Examples of these foods are dark green and leafy vegetables, such as spinach, kale, lettuce, in addition to cabbage, broccoli and cauliflower, for example. See the full list of foods rich in vitamin K.

Home remedies that should not be used with anticoagulants

It is common for people to use herbal medicines or home remedies without medical advice on a daily basis, because they think they are natural and that they are not harmful, however, some may interact, usually intensifying, the effect of anticoagulants which causes risk of bleeding and can endanger the person's life.

Therefore, people who use anticoagulant or anti-aggregating drugs should be especially careful when taking home remedies or food supplements prepared based on:

• Garlic; Ginkgo Biloba; Ginseng; Red sage; Guaco; Dong Quai or Chinese Angelica; Horse Chestnut; Boldo; Guarana; Arnica.

Due to this type of interaction between medications and natural remedies, it is important to only take medications after the doctor's indication or approval.