Normal people have a complete blood coagulation system, anticoagulation and fibrinolysis system, so blood does not coagulate or bleed in the blood vessels, and it always flows freely to complete its function. However, when the body is in a hypercoagulable state or when anticoagulation and fibrinolysis are weakened, embolic diseases are prone to occur. Anticoagulants can be used to prevent and treat intravascular embolism or thrombosis. They prevent the coagulation process by affecting certain coagulation factors in the coagulation process.

The choice of anticoagulant varies from person to person

Warfarin is an oral anticoagulant, It is a commonly used drug for the prevention and treatment of thromboembolic diseases, and is suitable for patients with atrial fibrillation, heart valve disease after valve replacement, and intracardiac thrombosis. Although various new oral anticoagulants, such as dabigatran etexilate, rivaroxaban, apixaban, etc. have emerged in an endless stream in recent years, warfarin is still widely used in cardiovascular diseases due to its high quality, low price and clear curative effect. It occupies an indispensable position in the prevention and treatment of thrombosis diseases.

Dabigatran etexilate has high stability and does not require regular monitoring of coagulation function. However, this type of drug needs to be taken for life and accumulates over the years, which is not a small cost. . After the dose of warfarin is properly controlled, the coagulation function only needs to be checked regularly, and the price is relatively cheap. The choice of which drug to use also varies from person to person.

Using warfarin

It should be taken at the same time every day:At the same time every day Take it, preferably in the afternoon or evening, to avoid interactions with other medicines. If you forget to take the medicine, please make up the dose within 4 hours. If it exceeds 4 hours, do not make up the dose. Take the medicine normally the next day, and do not take twice the dose.

Adjusting warfarin medication according to dose: There are two commonly used strengths of warfarin currently on the market: the domestic dosage form is 2.5 mg per tablet, The imported dosage form is 3 mg per tablet. The warfarin specifications and tablet colors of different manufacturers are different, and the same is domestic warfarin. Due to different processes, the curative effect may also be different. The dosage of the drug should be adjusted appropriately according to the doctor’s advice. After taking one type of warfarin on a regular basis, try to avoid switching to other products. If the medication regimen must be changed, blood coagulation indicators should be monitored, and the adjustment should be based on the dose, not the number of tablets.

Regular monitoring is required after taking warfarin: Diseases, diet, genetic factors, lifestyle habits, and other drugs can affect the anticoagulant effect of warfarin. Genetic differences can explain 30% to 40% of the dose differences. Demographic factors such as age, gender, and weight account for about 20%. Therefore, individual differences in doses are large. Periodic blood draws are required during medication to monitor the International Normalized Ratio (INR). and prothrombin time (PT).

When you start taking warfarin for 2~3 days, you should start monitoring INR every day or every other day. If the INR is within the standard range (2.0-3.0) for 3 weeks, it can be monitored once every 2 weeks, and it is still stable for 2-3 consecutive times, and it can be monitored once a month, with an interval of up to 1 month.

Beware of bleeding when using warfarin: The most common adverse reaction of warfarin is bleeding. Bleeding gums, nosebleeds, increased menstrual flow, blood in the stool, etc. There is no need to worry about a small amount of bleeding or ecchymosis. After monitoring the INR value, adjust the dose of the drug under the guidance of the doctor, stop the drug for a period of time if necessary, and recover after the bleeding stops. Such as sudden severe stomach pain, hematemesis, melena, etc., suggesting that serious bleeding may occur, you need to go to the hospital as soon as possible, under the guidance of a doctor for symptomatic treatment.

Avoid foods rich in vitamin K after taking warfarin: Vitamin K promotes blood clotting, while warfarin does The mechanism is to antagonize vitamin K and affect the coagulation function, so as to achieve the effect of anticoagulation. Many of the foods we are exposed to contain vitamin K, which can reduce the effectiveness of warfarin. The content of vitamin K in various foods is different, and when the diet structure changes greatly, it will also affect the efficacy of warfarin. Smoking and heavy drinking can also affect the efficacy of warfarin. It is recommended to quit smoking, quit drinking, and maintain good living habits.

rich Foods containing vitamin K, including garlic, onion, green leafy vegetables such as spinach, lettuce, broccoli, celery, lettuce, etc., milk, beans, animal liver, etc. Among them, green leafy vegetables and animal liver have higher vitamin K content, The content of meat and dairy products is moderate, and the content of fruits and grains is low. Therefore, we should try to maintain a balanced diet and avoid excessive intake of foods rich in vitamin K at one time, but it is not necessary to eliminate these foods completely. The dose of warfarin can be adjusted to maintain efficacy.

Dabigatran etexilate is safer than warfarin

Dabigatran etexilate was approved in China in 2013 for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation. It has fast onset of oral action, short half-life and high selectivity. , the therapeutic dose does not cause thrombocytopenia, and the anticoagulant effect is independent of vitamin K. Compared with warfarin, the advantages of dabigatran etexilate are that it does not require monitoring of coagulation function, less bleeding risk, and higher drug safety.

What should I do if dabigatran etexilate is missed

The half-life of dabigatran etexilate is short, 12～ The 24-hour anticoagulant effect is greatly reduced. If the dose is insufficient, blood clots will form; if the dose is excessive, it will cause bleeding and even life-threatening.

Accidental omission of dabirate Gatran etexilate, if it is more than 6 hours before the next dose, you can take it once again; if it is less than 6 hours before the next dose, you don’t need to take this time, and the next dose can be taken at the normal dose; if you are not sure whether Take the medicine, take it directly according to the next time of taking the medicine, do not have to worry about it ; If a double dose is taken by mistake, skip the next dose and take the original dose after that. It is recommended that patients can prepare a small pill box and take it regularly and quantitatively to ensure the efficacy of the drug.

I am taking warfarin, how to switch to dabigatran etexilate

Switching from warfarin to dabigatran For gatran etexilate, warfarin should be stopped first, and dabigatran etexilate should be taken immediately when INR < 2.0. When switching from dabigatran etexilate to warfarin therapy, the two drugs need to be used together for a period of time. When the monitored INR reaches the target value range (2.0-3.0), dabigatran etexilate is discontinued, considering that dabigatran etexilate may have adverse effects on The INR has a certain influence, and the INR should be closely monitored within 1 month after the discontinuation of dabigatran etexilate. After reaching the standard, the routine monitoring should be resumed.