Anticoagulants for aortic and mitral valve regurgitation

Examples

Coumarins

Generic Name	Brand Name
warfarin	Coumadin

Low-molecular-weight heparins (LMWH)

Generic Name	Brand Name
dalteparin	Fragmin
enoxaparin	Lovenox
tinzaparin	Innohep

Other antithrombotic medicines (selective Factor Xa inhibitors)

Generic Name	Brand Name
fondaparinux	Arixtra

Unfractionated heparins (UH)

Generic Name
heparin

How It Works

Anticoagulant medicines (also known as blood thinners) help prevent the formation of blood clots by increasing the time it takes a blood clot to form. This prevents a clot that has already formed from getting larger and reduces the chances that pieces of a clot will break off and cause a heart attack or stroke.

Why It Is Used

Anticoagulants are used in the treatment of mitral valve regurgitation and aortic valve regurgitation:

• When atrial fibrillation is present.
• After valve surgery. At this time there is an increased risk for blood clots. If you have a mechanical valve (made with metal or plastic), you will have to take anticoagulants for the rest of your life.

After heart valve replacement surgery, both Coumadin (warfarin) and one of several types of anticoagulant medicines—a low-molecular-weight heparin, an unfractionated heparin, or another antithrombotic medicine—are started. Coumadin is given in pill form while the other medicines are given as a shot. The injected medicines (low-molecular-weight heparin, unfractionated heparin, and an antithrombotic medicine called a selective Factor Xa inhibitor) act immediately, while Coumadin takes several days to become effective. When Coumadin begins to work, the other medicines are stopped.

How Well It Works

Anticoagulants prevent clotting of a mechanical heart valve. Anticoagulants can reduce the risk of stroke in people who have atrial fibrillation.

Side Effects

Bleeding is the most common side effect of anticoagulants.

Know the signs of bleeding

Call 911 if:

• You cough up blood.
• You vomit blood or what looks like coffee grounds.
• You pass maroon or very bloody stools.

Call your doctor right away if:

• You have new bruises or blood spots under your skin.
• You have a nosebleed that doesn't stop quickly.
• Your gums bleed when you brush your teeth.
• You have blood in your urine.
• Your stools are black and look like tar or have streaks of blood.
• You have heavy period bleeding or vaginal bleeding when you are not having your period.

If you are injured, apply pressure to stop the bleeding. Realize that it will take longer than you are used to for the bleeding to stop. If you can't get the bleeding to stop, call your doctor.

Warfarin may also cause a skin rash.

Heparin shots may cause irritation, pain, or bruising at the injection site.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

When you take anticoagulants, you need to take extra steps to avoid bleeding problems.

Warfarin. If you take warfarin, you need to:

• Get regular blood tests.
• Prevent falls and injuries.
• Eat a steady diet, and pay attention to foods that contain vitamin K.
• Tell your doctors about all other medicines and vitamins that you take.

For more information, see:

Warfarin: Taking your medicine safely.

Know what to do if you miss a dose of anticoagulant.

Heparin. If you take heparin, you need to:

• Prevent falls and injuries.
• Prevent medicine interactions.

Pregnancy. Do not take warfarin if you are pregnant or may become pregnant. If you are taking warfarin and think you may be pregnant, call your doctor. Warfarin can cause birth defects. If you become pregnant while taking warfarin, your doctor may recommend that you switch to a low-molecular-weight form of heparin while you are pregnant. Long-term use of these heparin formulations is not recommended, because it is associated with osteoporosis and thrombocytopenia.

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Author:	Robin Parks, MS	Last Updated: January 7, 2010
Medical Review:	E. Gregory Thompson, MD - Internal Medicine George Philippides, MD - Cardiology
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