Anticoagulant and Its Role in Elderly Health

Introduction:

The function of the blood is to carry gaseous and nutrients throughout the body. That is why the continuous flow of blood and its circulation throughout the body is necessary. However, several pathological disorders may cause unnatural clotting of blood. The function of the anticoagulant is to prevent clotting of the blood. These substances are used to prevent unnatural clotting of the blood within the blood vessels.

What Are the Indications of Anticoagulants in the Elderly?

Anticoagulants are recommended for various purposes for the elderly. The indications are;

1. Venous Thromboembolism (VTE) Prophylaxis:

The incidence of blood clots within veins gradually increases with age. The prevalence is higher in elderly individuals. In most cases, deep vein thrombosis and pulmonary embolism (blockage of the pulmonary blood vessels) are common. The risk factors for developing deep vein thrombosis are cancer, diabetes, heart disease, kidney disorders, obesity, systemic inflammation, and blood clotting disorders. Anticoagulants are used as prophylactic drugs to reduce the incidence of such clot formation.

2. Venous Thromboembolism (VTE) Treatment:

If the patient is already suffering from the presence of blood clots in the deep veins, anticoagulants are effective in treating such conditions.

3. Atrial Fibrillation:

Atrial fibrillation is the most common type of cardiac arrhythmia. This is nothing but tachyarrhythmia (increased heartbeat), which usually originates from above the AV node. An abnormal electrical activity within the atrium causes improper muscular twitching. This is responsible for atrial fibrillation and for a lot of ischemic cardiac events. That is why anticoagulants are advised for such patients.

4. Valvular Heart Disease:

These diseases are caused by defects in the heart valves. Conditions like rheumatic heart disease (heart disease caused by rheumatic fever), endocarditis (infectious disease of the heart valve), and autoimmune disorders are responsible for such complications. These valvular diseases cause valvular stenosis, atresia and regurgitation. Anticoagulants are necessary for such disorders.

What Are the Different Anticoagulants Used for the Elderly?

Different anticoagulants used for the elderly are;

1. Warfarin: This is a traditionally used anticoagulant that is used orally. Warfarin is responsible for the dysfunctionality of vitamin K. This causes improper functioning of coagulation factors II, VII, IX, and X. Also, the functionality of proteins such as protein S and protein C, which are essential for coagulation, is impaired. This drug is essential for the prophylactic treatment of venous thrombosis and pulmonary embolisms. Also, this is used as a drug for patients suffering from valvular heart disease and atrial fibrillation.

2. Heparins and Fondaparinux: Heparin is a useful prevention and treatment of deep vein thrombosis. In general, low-molecular-weight heparin is used for this purpose. Heparin can attach itself to various proteins. However, its interaction with antithrombin (a coagulating factor) is particularly significant, as it triggers a change on the surface and renders thrombin inactive. The binding of heparin to antithrombin obstructs multiple factors involved in the clotting pathways, such as thrombin (Factor IIa) and Factor Xa. By deactivating thrombin, heparin hinders the conversion of fibrinogen to fibrin, thereby preventing clot formation and extending the time it takes for blood to clot. It is worth noting that heparin does not impact bleeding time, but it does prolong the clotting time of blood. Heparin is administered via the intravenous route. On the other hand, low-molecular-weight heparin is administered via subcutaneous injection. Fondaparinux is a synthetic molecule of heparin that is used to prevent the functioning of factor Xa. This is administered subaqueously.

3. Antiplatelet Drugs: These are not anticoagulant drugs, but they also prevent blood coagulation by acting on the palates. Various drugs can be used for this purpose, these drugs are Aspirin and related cyclooxygenase inhibitors, oral thienopyridines, and glycoprotein platelet inhibitors. Low-dose aspirin acts on the prostaglandin pathway (an inflammatory pathway) and prevents platelet aggregation and narrowing of the blood vessels. These are used as oral medications. Oral thienopyridines act on adenosine diphosphate (an organic compound necessary for platelet functioning) and prevent platelet aggregation. The drugs belonging to this category are Clopidogrel, Ticagrelor, Ticlopidine, and Prasugrel. The glycoprotein inhibitors act on glycoprotein receptors on the platelets and prevent their aggregation. The drugs belonging to this category are Abciximab, Eptifibatide, and Tirofiban. These drugs are used for preventive purposes in disorders like myocardial infarction (a disorder caused by reduced blood flow to heart muscles), ischemic heart diseases (disease caused by reduced oxygen supply to the heart), and valvular heart diseases.

What Are the Newer Anticoagulants?

In recent times, several newer anticoagulants have been used for therapeutic purposes. These are;

1. Rivaroxaban: This is an oral factor Xa inhibitor. This is used for the treatment of deep vein thrombosis and blood clotting in the pulmonary artery. It is also used for patients undergoing surgery for the lower limb.

2. Apixaban: This is also an oral anticoagulant that acts on factor Xa. However, this is a selective inhibitor of factor Xa.

What Are the Precautions of Anticoagulant Therapy?

It should be kept in mind that anticoagulant therapy should follow the following guidelines;

1. Patients suffering from atrial fibrillation should be given Warfarin as an anticoagulant. Monitoring the blood coagulation status of these patients is necessary. Patients older than 75 years who have a high risk of stroke should continue chronic anticoagulant therapy.

2. For hospitalized patients who are suffering from venous thromboembolism, drugs like low-dose unfractionated heparin, low molecular weight heparin (LMWH), Fondaparinux, or Warfarin are prescribed. If the patient is suffering from other types of disorders like liver disorder, malnutrition, and congestive heart failure, a low dose of anticoagulant is preferred.

3. Anticoagulant therapy may cause renal impairment or kidney dysfunctions. As a result, monitoring of renal functions is required. Also, unfractionated heparin (UFH) is contraindicated in patients with kidney dysfunctions.

4. Low-molecular-weight heparin and Warfarin are contraindicated in patients suffering from severe hypertension, bleeding disorders, peptic ulcer disease (ulcer in the stomach), and recent cerebral hemorrhage (excessive bleeding inside the brain).

What Are the Adverse Effects of Anticoagulant Therapy?

The adverse effects associated with anticoagulant therapy are;

1. Excessive gastrointestinal bleeding is the most common side effect. Patients may also show symptoms like blood vomiting.

2. A low platelet count is often seen in patients receiving heparin therapy.

3. Loss of bone minerals may lead to osteoporosis.

4. Warfarin is associated with skin necrosis and severe hypersensitivity reactions.

Conclusion:

Anticoagulants are used in the elderly for both prophylactic and therapeutic purposes. These drugs help prevent blood clots within the vessels. Drugs like Heparin, Warfarin, and anti-platelet drugs are used for these purposes. However, regular assessment is needed to ensure patients' well-being.