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Clotting Disorder Treatment

Anticoagulation Treatment

The management of thrombotic (clotting) episodes ranges from the use of blood thinners during a new clotting event to the prophylactic (preventive) use of anticoagulants (blood clot prevention agents) during high-risk procedures such as surgery or pregnancy.

The length of anticoagulation therapy in individuals with an initial thrombosis is determined based upon a variety of factors, including:
The patient's age;
The presence of an identifiable clotting problem (such as factor V Leiden);
The size and site of the clot; and
Other additional risk factors such as the use of birth control pills, pregnancy or surgery.
Lifelong therapy should be considered for those with a history of several thrombotic episodes, one large life-threatening event such as a pulmonary embolus, and those with multiple risk factors or ongoing associated abnormal clotting triggers. A pulmonary embolus may not lead to a decision for lifelong anticoagulation in some circumstances, such as when the clot occurred during pregnancy or surgery.

Anticoagulants:

Heparin
Heparin has been used as a blood thinner since 1916. The action of heparin is through its ability to increase the capacity of a naturally occurring clotting factor, antithrombin III, to limit clot expansion/growth. Heparin may be given intravenously (IV) or as an injection just under the skin. When intravenous therapy is used, the patient is admitted to the hospital and closely monitored with laboratory tests.

In some circumstances, heparin therapy may be associated with a high risk of bleeding such as when it is used for individuals with gastrointestinal bleeding, uncontrolled high blood pressure or bleeding into the head.

Low Molecular Weight Heparin (LMWH)
LMWH is a form of heparin (blood thinner) that is more easily used by the body than unfractionated (regular) heparin. The biologic half-life of LMWH is longer than unfractionated heparin, and it is more completely absorbed from the subcutaneous tissue (the layer between the skin and muscle or fat). There also appears to be a decreased risk of heparin-induced thrombocytopenia (HIT) and osteoporosis with this product.

LMWH is given as a subcutaneous injection to prevent blood clots from occurring or to treat an active clot. It is usually given every 12 hours or on a daily basis. Most patients are taught to self-administer this medication at home.

Coumarin Agents
Oral coumarins thin the blood by interfering with the carboxylation or formation of the vitamin K-dependent clotting factors: II, VII, IX, and X. Proteins C and S are also vitamin K-dependent proteins that are also decreased during coumarin therapy.
Coumarin agents are often prescribed following a thrombotic event. Some patients are on this medication for a short period of time, while others require lifelong anticoagulation.

Coumadin® is the most commonly used form of the coumarin agents. The generic name for Coumadin is warfarin. While on coumarin agents for anticoagulation, patients have a laboratory test conducted called the prothrombin time and international normalized ratio (INR). This is used to measure how "thin" or anticoagulated the patient's blood is. The frequency of these tests depends upon:

1. The specific patient response to the medication;
2. Stability of the patient's INR over time;
3. Target INR; and
4. Range of INR desired.

Many factors can influence how well coumarins work. These factors include interaction with other medications such as herbal medications, the amount of vitamin K foods in the diet, and any concurrent illness. It is essential that patients on Coumadin notify all other members of their healthcare team (dentists, for example) that they are on anticoagulation therapy.

Coumadin cannot be used during pregnancy. If you become pregnant while taking this medication, please immediately notify your healthcare provider.