Facts About Blood Thinners

“There is increasing awareness that even nuisance bleeding complications are enough for some patients to stop therapy, especially since the benefits of antiplatelet therapy may not be readily apparent.”*

Among people 75 and older, usage of blood thinners has dramatically increased from 3-4% to 10-11% of the population.**

 

Medication Adherence

26% of atrial fibrillation (AF) patients 80 years or older stopped taking warfarin during the first year of therapy. 81% of the discontinuations were due to perceived safety issues, particularly concerns about bleeding.***

Warfarin is underprescribed in elderly patients, with only about 50% of eligible patients receiving therapy – doctors cite safety concerns as the reason.****

 

Information on Different Blood Thinning Drugs

Anti-platelet and anti-coagulant agents (or blood thinners) include over-the-counter products like Prescription blood thinners include products such as:  Coumadin (warfarin), Plavix (clopidogrel bisulphate), and Pradaxa (dabigatran).  Anti-platelet agents and anti-coagulants are used to reduce the rate at which blood clots.  Anti-platelet agents, as their name suggests, work by having an anti-platelet effect inhibiting the body’s own ability to clot blood.  However, they also inhibit the ability for the blood to clot when a person has a cut.  There are many types and specific brands of blood thinners on the market today.  Some of these products have been around for decades and others have been developed within the last few years.


Vitamin K Antagonists

Coumadin (warfarin) – Generic

Coumadin, whose chemical name is Warfarin, is one of the most widely prescribed and oldest blood thinners.  It is now sold as a generic medication at a very cheap price.  Warfarin is a Vitamin K antagonist, which means that it blocks the action of vitamin K, which is an important agent that the body uses to clot blood.  Over the last 50 years it has been the most popular blood thinner on the market.   It is now facing some serious competition from some the newest blood thinners that are proving to be safer and equally effective.


Heparin (Carbohydrate) drugs

Clexane

Lovenox – Sanofi-Aventis

Arixtra – GlaxoSmithKline

Heparin drugs are another popular blood thinner, sold under brand names such as Clexane, Lovenox, and Arixtra.  They work by use carbohydrates that make blood less likely to clot and break up current clots.

 

Thrombin (enzyme) inhibitor

Pradaxa (dabigatran) – Boehringer Ingelheim

Pradaxa is the first one of the many new blood thinners that have been developed over the last few years that has been approved already in the United States.  There are claims that this drug may be superior to and safer than Warfarin.


Salicylate

Aspirin

Aspirin is the most widely used drug in the world for the prevention of thrombotic cardiovascular events.   Aspirin is a very common drug, used by millions of people for pain and other reasons.  Aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) include branded products like Advil and Aleve, along with their generic equivalents ibuprofen and naproxen sodium.  The American Heart Association (AHA) recommends aspirin therapy for most men over age 50 and women over 60 to reduce the risk of cardiovascular events.  The American Diabetes Association puts forth a similar recommendation.


P2Y (platelet receptor) inhibitor

Plavix (clopidogrel) – Bristol-Myers Squib and Sanofi-Aventis

There are more than 2 million people in the U.S. that are currently taking Plavix.  In addition, there are about 1 million people that receive stents every year and they are usually prescribed Plavix after the procedure.  This has led to Plavix being the second-best selling drug in the world.

 

Xa Inhibitors

Xa inhibitors are a new form of blood thinners that have been developed over the last few years.  Xa inhibitors function by blocking the Factor X enzyze involved in the coagulation pathway.  Two examples of Xa inhibitors are Rivaroxaban and Apixaban.

Xarelto (rivaroxaban) – Janssen

Rivaroxaban is a pill developed by the Johnson & Johnson and Bayer AG is currently for sale for sale in Europe and awaiting approval in the United States.  There are claims that it may be superior to Warfarin in bleeding risk and stroke prevention.  It sells under the name Xarelto.

Eliquis (apixaban) – Bristol-Myers Squibb and Pfizer

Apixaban is also a Xa inhibitor that sells under the name Eliquis.  The ARISTOTLE study demonstrated that Eliquis reduced the risk of stroke or systemic embolism by 21 percent, risk of major bleeding by 31 percent, and mortality by 11 percent.

 

Other Blood Thinners

Brilinta (ticagrelor) – AstraZeneca

Effient (prasugrel) – Lilly

Aggrenox (ASA+dipyridamole)

 

*Cohen M. Expanding the recognition and assessment of bleeding events associated with antiplatelet therapy in primary care. Mayo Clin Proc. 2009;84:149-160.
**”Trends in the Health of Americans.” National Center for Health Statistics (2011). Web. http://www.cdc.gov/nchs/hus.htm
***Hohnloser, MD, Stefan H. “Stroke Prevention Versus Bleeding Risk in Atrial Fibrillation.” Journal of the American College of Cardiology 57.2 (2011): 181-83. Print.
****Garwood, Candice L., and Tia L. Corbett. “Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls.” The Annals of Pharmacotherapy 42 (2008): 523-32. Web. www.theannals.com