ANTITHROMBOTIC DRUGS

ANICOAGULANTS VS ANTIPLATELET DUGS

There are two classes of antithrombotic drugs: anticoagulants and antiplatelet drugs.
Anticoagulants slow down clotting, thereby reducing fibrin formation and preventing clots from
forming and growing.
Antiplatelet agents prevent platelets from clumping and also prevent clots from forming and
growing.
 Both anticoagulants and antiplatelets reduce or prevent clotting. But they work in different ways.
 Antiplatelets interfere with the process of platelets binding together. Anticoagulants, also called
blood thinners, interfere with proteins in your blood that are involved with clotting.
 ANTICOAGULANT DRUGS
Anticoagulants may be divided into four main groups: coumarin derivatives ( warfarin), direct
factor Xa inhibitors( rivaroxaban), indirect thrombin inhibitors(heparins) and direct
thrombin inhibitors . Can be administered orally or parenteral.
Heparin acts immediately and is given intravenously (through the veins). Warfarin is swallowed in tablet
form, but its anticoagulant effect is delayed for days. Therefore, until recently, patients requiring
anticoagulants who were admitted to a hospital were started on a heparin infusion and were then discharged
from the hospital after five to seven days on warfarin.
Anticoagulants achieve their effect by suppressing the synthesis or function of various
clotting factors that are normally present in the blood. The primary effect of anticoagulants
is, as the name implies, an inhibition of the coagulation mechanism. Heparin is a sulfated
polysaccharide and it produces its major anticoagulant effect by inactivating thrombin and
activated factor X (factor Xa) through an antithrombin (AT)-dependent mechanism.
Warfarin is best suited for anticoagulation (clot formation inhibition) in areas of slowly running
blood (such as in veins and the pooled blood behind artificial and natural valves). Thus, common
clinical indications for warfarin use are atrial fibrillation, the presence of artificial heart valves, 
deep venous thrombosis, and pulmonary embolism 
 Advese effects
The most common side effect of anticoagulant is hemorrhage, but depending n the degree of
haemorrhage. An unexplained fall in blood pressure with dizziness while the patient is on an
anticoagulant should warrant an investigation into the possibility of an internal bleed.
Spinal or epidural bleeding followed by clots may occur in patients taking low molecular weight
heparins, rivaroxaban, edoxaban, fondaparinux and dabigatran following spinal procedures like
spinal puncture. This may result in paralysis.
The chances of bleeding can be reduced by choosing the right anticoagulant for the right patient
and the right dosage.
Heparin-induced thrombocytopenia: Unfractionated heparin or warfarin can reduce platelet count
and may result in the formation of blood clots within blood vessels. Therefore, platelet counts
have to be routinely performed in patients receiving this form of heparin.
Warfarin can also cause warfarin necrosis in patients with protein C deficiency and osteoporosis.
Allergic reactions can occur with anticoagulants, which may vary from itching and rashes to a
severe reaction with breathing difficulties, fall in blood pressure and even death.
Digestive tract disorders, birth defects, hair loss and ineraction with other drugs ( blood test INR is
recommended to determine the clot tendency of blood) are same other side effects.
 ANTIPLATELET DRUGS

Blood platelets are inactive until damage to blood vessels or blood coagulation causes them to
explode into sticky irregular cells that clump together and form a thrombus. The first antiplatelet
drug was aspirin, an cyclooxygenase inhibitor, which has been used to relieve pain for more than
100 years. Antiplatelet drugs are sometimes used to prevent blood clots, heart attacks and
strokes, but are primarily used to prevent the recurrence of blood clots after a heart attack or
stroke. 
  This is more common in people with certain medical conditions, such as:
• Angina.
• Atrial fibrillation.
• Coronary artery disease.
• History of heart attack or warning signs of a possible heart attack in the future.
• History of stroke or warning signs of a possible stroke in the future.
• Peripheral vascular disease (clogged veins and arteries outside of your heart that cause problems with circulation).
• Surgery, such as coronary artery bypass, angioplasty (placement of stents to open arteries) or heart-valve surgery.
Most antiplatelet drugs are pills that you swallow (oral), but some are given intravenously (injected into a vein).
You can take oral antiplatelet medications with or without food.
The main risk with antiplatelet drugs is excessive bleeding. Oher risks are :
Digestive tract disorders: Aspirin causes gastric irritation which can give rise to ulceration and bleeding.
Allergic reactions: Aspirin can cause allergic reactions with symptoms of sneezing and tearing of eyes, extending to more serious conditions
like difficulty in breathing, swelling of subcutaneous tissues
Reduced blood counts: Ticlopidine reduces the counts of red blood cells, white blood cells, and platelets. 
Kidney damage
Nervous disorders: Aspirin can affect the nervous system resulting in symptoms like agitation, confusion, dizziness, tinnitus (abnormal
sounds in the ear) and hearing loss.
Cardiac side effects: Cilostazol causes palpitations, arrhythmias and can cause heart attack in predisposed individuals.
Interaction with other drugs: 
If you take too many antiplatelet pills, it can be life-threatening. Never take more than what your healthcare provider prescribed.
 ANTITHROMBOTIC AND DENTAL EXTRACTION
Patients who use anticoagulants should be treated after consultation with their treating physician.
What basically concerns the dentist is the type of anticoagulant and the condition which is
administered. Some examples :
Coumarin drug : the prothrombin time must be in a range of 17-19 s on the day of surgery with a
gradual reduction of the therapeytical dosage at least 2 days beforehead.
Heparin drugs : must be discontinued at least 4h before the dental procedure. Postoperatively if there
is no profuse bleeding may be administered at the same day
Aspirin : must be discontinied at least 2-5 days before the surgical procedure and may continue it 24h
later.
Patients with artificial heart valves, severe venous thrombois or vascular grafts who discontinued the
therapy for dental extraction must resume the anticoagulant as soon as possible because of increased
risk of embolism due to thrombi.
 Conclusion
Antithrombotic therapy has had an enormous impact in several significant ways. Heparin has made
bypass surgery and dialysis possible by blocking clotting in external tubing. Antithrombotic
therapy has reduced the risk of blood clots in leg veins (also known as deep-vein thrombosis or
DVT), a condition that can lead to death from pulmonary embolism (a clot that blocks an artery to
the lungs) .And most importantly, it has markedly reduced death from heart attacks, the risk of
stroke in people with heart irregularities (atrial fibrillation), and the risk of major stroke in patients
with mini-strokes. Antithrombotic medication althogh their side effects it still considered a
correct teatment uder the correct instrutions.
 BIBLIOGRAPHY
 Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in o
ral and maxillofacial surgery - PubMed (nih.gov)
 Common Side Effects of Anticoagulants | Blood Thinners (medindia.net)
 Anticoagulant medicines - NHS (www.nhs.uk)
 Interruption of Antiplatelet Therapy Unnecessary for Tooth Extraction | tctmd.com
 Antiplatelet Drugs: Types, Uses & Side Effects (clevelandclinic.org)