Samwel Mikaye: Anticoagulants vs Antiplatelets
Samwel Mikaye, CEO of SaMik Medical Center, shared on LinkedIn:
”Anticoagulants vs Antiplatelets
These are two main classes of drugs used to prevent or treat thromboembolic disorders, but they act differently in the coagulation process.
1. Anticoagulants
Definition: Drugs that inhibit the coagulation cascade, reducing fibrin formation and clot extension.
Mechanism of Action
• Vitamin K antagonists (e.g., Warfarin): inhibit synthesis of clotting factors II, VII, IX, X
• Heparin (unfractionated and LMWH): potentiates antithrombin → inhibits thrombin (IIa) and factor Xa
• Direct oral anticoagulants (DOACs):
• Direct thrombin inhibitors: Dabigatran
• Factor Xa inhibitors: Rivaroxaban, Apixaban
Indications
• Deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Atrial fibrillation (stroke prevention)
• Mechanical heart valves (Warfarin)
• Myocardial infarction (certain cases)
Monitoring
• Warfarin: INR
• Heparin: aPTT (unfractionated)
• LMWH / DOACs: usually no routine monitoring
Adverse Effects
• Bleeding (major complication)
• Heparin-induced thrombocytopenia (HIT)
• Teratogenicity (Warfarin)
2. Antiplatelets
Definition: Drugs that inhibit platelet activation and aggregation, preventing arterial thrombus formation.
Mechanism of Action
• Aspirin: inhibits cyclooxygenase → ↓ thromboxane A₂ → prevents platelet aggregation
• P2Y12 inhibitors: Clopidogrel, Ticagrelor → block ADP receptor on platelets
• GP IIb/IIIa inhibitors: Abciximab, Tirofiban → block fibrinogen binding to platelet receptor
Indications
• Acute coronary syndrome (ACS)
• Myocardial infarction and stroke prevention
• Percutaneous coronary intervention (PCI)
• Peripheral arterial disease
Adverse Effects
• Bleeding (mostly gastrointestinal)
• Thrombocytopenia (rare)
• Gastrointestinal irritation (aspirin)”
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