Anticoagulants and Antiplatelet Therapy
Your Heart and Blood Clots You ve been told by your healthcare provider that you have a condition that can cause blood clots. This may be due to several factors, including: A damaged or artificial heart valve. Coronary artery disease (CAD) narrowing in the heart s coronary arteries, caused by fatty deposits in the artery walls called atherosclerosis. An arrhythmia (irregular heart beat), such as atrial fibrillation, in which the heart s upper chambers quiver instead of beating with a normal rhythm. Narrowing in the legs arteries or veins due to atherosclerosis or other problems. If you have any of these conditions, a blood clot may form which could travel to a coronary artery, and block blood flow to part of your heart muscle. This can lead to a heart attack. A clot could also break off from the inner wall of a blood vessel or within the heart itself. The clot could travel through the bloodstream and block a vessel in another part of the body. For example, if a clot travels to the brain, a stroke can result. A clot that travels to the lungs can cause a pulmonary embolism. 1
To help prevent blood clots, your healthcare provider may prescribe a medication called an anticoagulant (blood thinner) or an antiplatelet agent. Both medications reduce blood clotting. They can help keep harmful clots from forming in your heart and blood vessels throughout your body. Your peace of mind is why we have created this booklet to provide information about common treatments to prevent blood clots. 2
Understanding Anticoagulants Anticoagulants may be taken by mouth or injection. You and your healthcare provider will discuss the best medication options for you based on your health history. He or she will tell you how much and when to take each dose. Keep track of your medication and dosage using the medication chart on page 14. Types of Anticoagulants The two most commonly used choices for anticoagulation for many years have been warfarin (brand name Coumadin) and heparin. Today there are several new medication options which are effective in preventing blood clots, including dabigatran, rivaroxaban, apixaban and edoxaban. These medications are called non-vitamin K antagonist oral anticoagulants (NOACs). They may also be referred to as direct-acting oral anticoagulants (DOACs). Note: Since anticoagulants cause the blood to take longer to clot, the most serious potential side effect is bleeding. Talk to your healthcare provider about the signs of increased bleeding risk and the steps to take if you develop a bleeding problem. 3
Taking Other Medications While on Anticoagulants Some drugs lessen the action of anticoagulants. Others increase it. Ask your healthcare provider before you take any drug he or she didn t prescribe. This especially includes aspirin or products containing aspirin. It also includes cold remedies, painkillers, vitamins, tonics, herbal medications or supplements, sleeping pills and antibiotics. Also, talk to your healthcare provider about how tobacco and alcohol may affect your condition. And never stop taking a prescribed medication without talking to your healthcare provider first! Vitamin K Intake Foods rich in Vitamin K can reduce the effectiveness of anticoagulants like warfarin. Vitamin K is found naturally in leafy, green vegetables such as broccoli, cabbage, spinach and Brussels sprouts. Other foods rich in Vitamin K include fish, liver, lentils, soybeans and certain vegetable oils. Talk to your healthcare provider about how much and what kinds of these foods are safe for you to eat. 4
Why Blood Tests are Needed How well anticoagulants work can vary from person to person and over time. While you are on anticoagulant medication, you may need to have regular blood tests to check how long it takes your blood to clot. This helps your healthcare provider to control the dosage to keep the medication from causing you to bleed. 5
Types of Blood Tests The blood test used for people taking warfarin (Coumadin) is called a prothrombin time (PT) or the international normalized ratio (INR) test. PT is measured in seconds the time it takes for your blood to clot. Your PT result will be reported as an INR number. The usual number range seen for the INR while taking warfarin is about 2.0 3.0. PT testing while taking warfarin is usually done about once every month (every four weeks). The name of the blood test for people taking heparin is called an activated partial thromboplastin time, or a PTT test. This test is also measured in seconds. It s important that blood samples are taken as often as your healthcare provider instructs. NOACs do not require a routine blood test to monitor their effect on blood clotting. However, it is important to have regular blood tests to check your kidney function. 6
Understanding Antiplatelet Agents Platelets are small particles in the blood that can clump together to form blood clots. These blood clots can lead to heart attack and to the sudden clotting of a coronary stent. Antiplatelet agents keep the platelets from clumping together and forming blood clots. Many heart attack and stroke patients and people seeking to avoid these events are treated with two types of antiplatelet agents to prevent blood clotting. This is called dual antiplatelet therapy (DAPT). You may have been prescribed DAPT if you had a heart attack, were treated with stents in your coronary arteries or had coronary artery bypass graft surgery (CABG). 7
8
Types of Antiplatelet Agents One antiplatelet agent is aspirin. Almost everyone with coronary artery disease, including those who have had a heart attack, stent or CABG, are treated with aspirin for the rest of their lives. A second type of antiplatelet agent, called a P2Y 12 inhibitor, is usually prescribed for months or years in addition to the aspirin therapy. You may be prescribed one of three P2Y 12 inhibitors clopidogrel, prasugrel or ticagrelor. Which Medication will be Prescribed Studies have shown that ticagrelor and prasugrel are stronger than clopidogrel, and are a little better at decreasing the complications of blood clots. These two stronger agents, however, slightly increase bleeding. Prasugrel should not be prescribed if you have had a stroke or a transient ischemic attack (TIA). Which one of these medications your doctor prescribes and the length of time you will need to take it will be based on what he or she feels is best for you, based on your risk of blood clots and bleeding. Keep track of your medication and dose using the medication chart on page 14. 9
Signs to Watch For Ill effects from taking anticoagulants or antiplatelet agents are rare. If you follow your healthcare provider s advice, you shouldn't need to worry. However, call him or her at once if you have: Pain, swelling or discomfort. Bleeding from a cut that doesn't stop in the usual amount of time. Nosebleeds or bleeding from the gums. Blood when you cough up mucus or vomit. Unusual bleeding or bruising. Red or dark brown urine. This could be a sign of urinary tract bleeding. Red, dark brown or black bowel movements. This could be a sign of intestinal bleeding. Unusually large amount of bleeding when you have your period. Very bad or prolonged headache or stomach pain. Other illnesses can reduce your tolerance for the medication. See your healthcare provider right away if you are ill or feel weak, faint or dizzy. Also tell your healthcare provider if: You have bruises or blood blisters. You may be pregnant. You have fallen, had an accident or have received blows or other injuries. 10
11
Other Considerations Here are some other things to keep in mind while taking anticoagulants and antiplatelet agents. Friends and Family Be sure your family or other caregivers know the name and contact number of your healthcare provider. They should also know the reasons you are taking medications. Tell them what anticoagulant or antiplatelet agent(s) you re taking and alert them to the signs of problems (see page 10). They will then be able to alert your healthcare provider or medical staff in case of an emergency. Other Medical Professionals Tell your other healthcare providers and dentists that you're taking anticoagulants or antiplatelet agents well before any planned procedure or surgery. He or she may tell you to stop taking your medication before the procedure. If you ll be out of town for a while, tell your healthcare provider. He or she can refer you to another healthcare professional, if needed, or help you coordinate any lab work that may be needed while you are away. 12
Carry Emergency Medical ID List the name of the anticoagulant or antiplatelet agent(s) you are taking on an emergency medical ID card. Don t forget to put your name, telephone number and address on the card. Also include the name, address and telephone number of your healthcare provider. Always carry it in your purse or wallet so it can be found quickly and easily in case of emergency. Some people wear a medical alert bracelet. 13
Medication Tracker List all of your medications here for easy reference. At the bottom, write the name of your primary caregiver or caregivers and their phone numbers. Keep this list with you. Medication: Dose: How Often: Taken For: Date Prescribed: / / Medication: Dose: How Often: Taken For: Date Prescribed: / / Medication: Dose: How Often: Taken For: Date Prescribed: / / Medication: Dose: How Often: Taken For: Date Prescribed: / / Cut along dotted line and keep Primary Caregiver: Phone Number: Other Caregiver: Phone Number: 14
For More Information We want people to experience more of life s precious moments. To do that, we want to help you be healthier in heart and mind. It s why we ve made better heart and brain health our mission. Life is why we have created many educational booklets like this to help you and your family make healthier choices to reduce your risk of heart disease and stroke, manage disease or care for a loved one. Everyone has a reason to live a longer, healthier life. What s the why in your life? Maybe it s walking your daughter down the aisle. Watching that perfect sunset with your spouse. Or simply giving your grandchild a big hug. Whatever your why, we encourage you to write it down here. Look back at your why often, and use it to inspire you as you work to live a longer, healthier life. is why. To learn more, call us toll-free at 1-800-AHA-USA1 (1-800-242-8721) or contact your nearest American Heart Association office. You can also visit our Web site, heart.org. For information on stroke, call 1-888-4-STROKE (1-888-478-7653) or visit us online at strokeassociation.org. 15
Heart Attack Warning Signs Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort. Here are some of the signs that can mean a heart attack is happening. Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath. This may occur with or without chest discomfort. Other signs. These may include breaking out in a cold sweat, nausea or lightheadedness. As with men, women s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. Stroke Warning Signs Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, or trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness or loss of balance or coordination Sudden, severe headache with no known cause F.A.S.T. is an easy way to remember how to recognize a stroke and what to do. Spot a stroke FAST. Face drooping. Arm weakness. Speech difficulty. Time to call 9-1-1. Dial 9-1-1 Fast Heart attack and stroke are life-or-death emergencies every second counts. If you suspect you or someone you are with has any of the symptoms of heart attack or stroke, immediately call 9-1-1 or your emergency response number so an ambulance can be sent. Don t delay get help right away! For a stroke, also note the time when the first symptom(s) appeared. If given within 3 to 4.5 hours of the start of symptoms, a clot-busting drug may improve the chances of getting better faster. Cut along dotted line and keep
For heart- or risk-related information, call the American Heart Association at 1-800-AHA-USA1 (1-800-242-8721) or visit us online at heart.org. For stroke information, call our American Stroke Association at 1-888-4-STROKE (1-888-478-7653) or visit strokeassociation.org. For information on life after stroke, call and ask for the Stroke Family Support Network. The statistics in this brochure were up to date at publication. For the latest statistics, see the Heart Disease and Stroke Statistics Update at heart.org/statistics. National Center 7272 Greenville Avenue Dallas, Texas 75231-4596 2017, American Heart Association. All Rights Reserved. Published and distributed by The StayWell Company, LLC. To order, call: 800-333-3032 www.kramesstore.com/aha 50-1730 1707