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Blood Thinners for Heart Disease

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Blood Thinners for Heart Disease
Bivalirudin
Warfarin (Coumadin)
Aspirin
Clopidogrel (Plavix)
Super Aspirins
References

Heparins

What is heparin?

Heparin is an anticoagulant or blood thinning drug that reduces the chance of blood clots forming. It is given through an intravenous (IV) line in the arm.

What is it used for?

Heparin is used to prevent clotting during bypass surgery and angioplasty.1 It is also given to heart attack patients treated with some clot busters, and it is used to treat or prevent blood clots in the deep veins of the lower legs or in the lungs.

What are the risks of heparin?

Because heparin affects the blood's ability to clot, it can lead to bleeding problems. Women and elderly patients tend to have more bleeding problems than men or younger people treated with heparin.1 Adjusting doses for people with smaller body weights helps reduce the risk of bleeding problems. Lower doses of heparin are also used when it is combined with other blood thinning drugs such as the super aspirins ( glycoprotein IIb/IIIa inhibitors). Heparin can increase the risk of hemorrhagic stroke — bleeding in the brain — especially when it is combined with clot busters.2

Heparin may trigger a type of allergic reaction that results in a dangerously low level of platelets (a type of blood cell involved in clotting). Platelets are also called thrombocytes and this reaction is called heparin-induced- thrombocytopenia (HIT for short). If you are given heparin in the hospital, you will have your blood drawn and tested every day to see if your platelet counts are normal.

Heparin Quick Reference Table

HEPARIN
http://www.spl-pharma.com/PDF/tds-heps.pdf
(check with manufacturer for more specific information)

How is it given:

Injected into an IV line or under the skin

What is it used for:

To prevent clotting during cardiac surgery
To treat or prevent blood clots in the deep veins of the lower legs (deep vein thrombosis) in people at risk
To treat or prevent blood clot in the lung ( pulmonary embolism)
To prevent or treat blood clots associated with rapid, irregular heartbeat ( atrial fibrillation)

You should not be treated with it if:

You are bleeding severely.
You have a dangerously low platelet count.

Pregnancy/nursing:

It is not known whether heparin is safe for pregnant women. Heparin is not excreted in breast milk.

 

What is low molecular weight heparin (LMWH)?

Low molecular weight heparin (LMWH) is an anticoagulant like heparin. Anticoagulants reduce the likelihood of blood clots forming.

Finding the right dose of heparin for each patient is tricky; hospital staff must run blood tests and make dose adjustments if necessary. LMWH does not require such close monitoring. It is also easier to administer: LMWH is injected under the skin twice a day whereas regular heparin is given through an IV line in the arm.

What is LMWH used for?

LMWH is used to treat blood clots in the deep veins of the lower legs (deep vein thrombosis, or DVT) and to treat unstable angina and a mild heart attack. Research is ongoing to see whether LMWH can be substituted for regular heparin. There is evidence that LMWH is as good as, if not better, than heparin in some cases – in the treatment of unstable angina, for example.1This benefit was seen in women as well as men.

However, LMWH is not significantly better than regular heparin during angioplasty and bypass surgery. Results vary for the different types of LMWH. For example, studies found enoxaparin (Lovenox) to be better than regular heparin, but dalteparin (Fragmin) was not.3 Regular heparin is a tried and trusted medication; it was the medication used in most research studies on super aspirins (glycoprotein IIb/IIIa inhibitors). For these reasons, LMWHs have yet to completely replace regular heparin. LMWH is generally preferred for people with unstable angina (chest pain) or a mild heart attack, unless they are likely to undergo bypass surgery.

LMWH Quick Reference Table

LMWH
(Check with manufacturer for specific information)

Generic:

Enoxaparin

Dalteparin

Brand:

Lovenox
http://www.lovenox.com/consumer/default.aspx

Fragmin
www.fragmin.com/

How is it given:

Injected under the skin

Injected under the skin

What is it used for :

To treat blood clots in the deep veins of the lower legs (deep vein thrombosis)
To treat unstable angina and a mild heart attack

You should not be treated with it if:

  • You are bleeding severely
  • You have a low platelet count
  • You are allergic to heparin or pork products
  • You should not receive Fragmin if you are undergoing local anesthesia.

Pregnancy/nursing:

It is not known whether these medications are safe during pregnancy or nursing.

 



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