Below is a list of anticlotting medications that doctors may prescribe:
- warfarin (Coumadin, Jantoven): Side effects include bleeding from any tissue or organ. It is not recommended for people who have active ulcers. It requires routine blood testing. Certain medications including antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and barbiturates may boost the bleeding effect of warfarin.
- dabigatran (Pradaxa): Side effects include stomach pain, heartburn, nausea. Serious side effects include bleeding, joint pain or swelling, headache, swelling of the arms or lower legs. It is a useful alternative to warfarin for people with atrial fibrillation who are at risk of stroke. Not for use in people with certain kidney diseases, liver disease, or those with a mechanical heart valve.
- clopidogrel (Plavix): Side effects include stomach pain, nausea, headache, and dizziness. Serious side effects include bleeding, hives, rash, liver dysfunction, and swelling of the face, hands, and feet. It may be less effective in people taking heartburn drugs such as omeprazole (Prilosec) and esomeprazole (Nexium). About 3% of whites and blacks and up to 20% of East Asians have a genetic variation that diminishes the drug's effectiveness. Genetic tests are available to identify people with this variant.
- prasugrel (Effient): Side effects include dizziness, excessive tiredness, headache, or pain in the back, arms, or legs. Serious side effects include shortness of breath and a slow, fast, or irregular heartbeat. Should not be taken by people who have a history of ulcers or other internal bleeding, or who have had recent surgery, a stroke or a mini-stroke, or liver disease.
Glycoprotein inhibitors are given intravenously in the hospital to people who have unstable angina or who have had certain types of heart attacks, as well as those undergoing angioplasty or other invasive heart procedures:
- abciximab (ReoPro): Side effects include bleeding, dizziness, nausea, vomiting, headache, back pain, slow heart rate. Unsafe for people with recent bleeding episodes, bleeding problems, who have had recent surgery, or who have had a stroke within two years.
- tirofiban (Aggrastat): It is unsafe for people with kidney problems.
- eptifibatide (Integrilin): Dosage should be monitored and adjusted carefully in people with kidney problems.
More Answers from Anthony Komaroff, MD