What are anticoagulants (blood thinners)?

From the Guidelines

Blood thinners, specifically direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, apixaban, and edoxaban, are the preferred choice for stroke prevention in patients with atrial fibrillation and for prevention and treatment of venous thromboembolism due to their effectiveness and lower risk of life-threatening bleeding compared to vitamin K antagonists (VKAs) 1. When considering the use of blood thinners, it's essential to weigh the benefits of preventing blood clots against the risk of bleeding. The DOACs have been shown to be at least as effective as VKAs but are associated with less life-threatening bleeding, particularly intracranial hemorrhage 1. Some key points to consider when using blood thinners include:

• The DOACs are licensed for stroke prevention in patients with atrial fibrillation and for prevention and treatment of venous thromboembolism 1
• Antidotes for the DOACs, such as idarucizumab (Praxbind), andexanet alfa, and ciraparantag (PER977), are under development or already licensed for use in cases of serious bleeding or urgent interventions 1
• The outcomes of major bleeds with DOACs are no worse than those with VKAs even in the absence of clinically available antidotes 1
• It's crucial to take blood thinners exactly as prescribed, avoid missing doses, be cautious with activities that could cause injury, watch for unusual bleeding or bruising, inform all healthcare providers about your medication, and wear medical identification. The development of antidotes for the DOACs has improved the management of serious bleeding and rapid reversal of anticoagulation before urgent interventions, making DOACs a safer choice for patients requiring blood thinners 1.

From the FDA Drug Label

Apixaban tablets are a prescription medicine used to: • reduce the risk of stroke and blood clots in people who have atrial fibrillation • reduce the risk of forming a blood clot in the legs and lungs of people who have just had hip or knee replacement surgery. • treat blood clots in the veins of your legs (deep vein thrombosis) or lungs (pulmonary embolism), and reduce the risk of them occurring again.

XARELTO is a prescription medicine used to: reduce the risk of stroke and blood clots in adults who have a medical condition called atrial fibrillation that is not caused by a heart valve problem treat blood clots in the veins of your legs (deep vein thrombosis or DVT) or lungs (pulmonary embolism or PE) reduce the risk of blood clots from happening again in adults who continue to be at risk for DVT or PE after receiving treatment for blood clots for at least 6 months.

The objective of anticoagulant therapy is to decrease the clotting ability of the blood so that thrombosis is prevented, while avoiding spontaneous bleeding.

Blood Thinners are medications that prevent blood clots from forming or growing. The drugs mentioned, apixaban, rivaroxaban, and warfarin, are all used to prevent stroke and blood clots in people with certain medical conditions, such as atrial fibrillation, deep vein thrombosis, or pulmonary embolism.

• Apixaban and rivaroxaban are used to reduce the risk of stroke and blood clots in people with atrial fibrillation, and to treat and prevent deep vein thrombosis and pulmonary embolism.
• Warfarin is used to prevent thrombosis and thromboembolism, and is often used in people with atrial fibrillation, deep vein thrombosis, or pulmonary embolism.

It is essential to follow the prescribed dosage schedule and attend regular check-ups with your physician to monitor therapy while taking these medications 2, 3, 4.

From the Research

Blood Thinners

• Blood thinners, also known as anticoagulants, are medications used to prevent and treat blood clots in the veins and arteries 5, 6, 7, 8.
• The choice of blood thinner depends on the individual patient's condition, such as deep vein thrombosis, pulmonary embolism, or atrial fibrillation 5, 6, 8.
• Common blood thinners include:
  • Low-molecular-weight heparin (LMWH) 7, 8
  • Warfarin 7, 8
  • Novel oral anticoagulants (NOACs) such as apixaban, rivaroxaban, and edoxaban 6, 8, 9
• The dosing regimen of blood thinners can vary, with some medications administered once daily and others twice daily 9.
• The selection of a blood thinner and its dosing regimen should be tailored to the individual patient, taking into account factors such as efficacy, safety, and adherence to therapy 9.

Treatment of Venous Thromboembolism

• The acute treatment of venous thromboembolism (VTE) typically involves intensified anticoagulation with a blood thinner such as LMWH or a NOAC 5, 6.
• The duration of anticoagulation therapy for VTE can vary, but it is typically recommended for 3-6 months 5.
• Extended anticoagulation with a blood thinner such as apixaban can reduce the risk of recurrent VTE without increasing the risk of major bleeding 6.

Prevention of Stroke in Atrial Fibrillation

• Blood thinners such as warfarin and NOACs are effective for preventing stroke in patients with atrial fibrillation 8, 9.
• The choice of blood thinner for stroke prevention in atrial fibrillation depends on the individual patient's risk factors and preferences 8, 9.
• Apixaban has been shown to be effective for stroke prevention in atrial fibrillation, with a lower risk of major bleeding compared to warfarin 8.