Anticoagulation therapy is recommended for precenting, treating and reducing the recurrence of venous thromboembolism, and preventing stroke in persons with atrial fibrillation.
The first-line agents are the direct oral anticoagulants (Eliquis, Xarelto, Pradaxa) for treating venous thromboembolism and preventing stroke in patients with nonvalvular atrial fibrillation. They provide more immediate anticoagulation.
These drugs have the advantages of not requiring lab monitoring, have minimal drug interactions and a quicker onset of action. Eliquis has less major bleeding than other drugs in this group and coumadin. The other drugs also have a higher risk of gastrointestinal bleeding than Eliquis. Compared with coumadin this class of drugs has a reduced incidence of stroke and a reduction in cerebral hemorrhage.
Coumadin that works a s a vitamin K antagonist requires a minimum of 5 days with overlap of injections. Vitamin K injections are used to reverse the effects of coumadin if INR is greater than 10. Blood test PT/INR are done to monitor levels and coumadin dosage adjusted to reach therapeutic levels.
Older patients and those with liver disease, poor nutritional status, heart failure, diarrhea, fever and hyperthyroidism, and genetic factors may require lower doses of coumadin. Levels should be checked at least every 12 weeks in stable patients.
Foods that vare high in vitamin K such as green leafy vegetables have the potential to reverse the effects of coumadin
Drugs that interfere with coumadin and potentiate INR levels include;
* Antibiotic- Bactrim, Cipro, Biaxin, Diflucan, Flagyl
*Cardiac medications-Amiodarone, Lescol, Lopid, Mevacor
*Alternative medication-Garlic, Devik's Claw and Ginkgo Biloba
Lovenox (low molecular weight heparin injections) is recommended first line in patient with venous thromboembolism and active cancer. There is growing evidence for use of direct oral anticoagulants in this group.
The duration of treatment has many variables but may last from 3 to 6 months or lifelong.
Dr Drake is board certified by The American Board of Family Medicine and is a past-president of the Kentucky Academy of Family Physicians and is a member of the American Academy of Family Physicians. Dr Drake has practiced in Somerset since 1984.
Information for this article was from American Family Physician 10-1-19