How Efficient Are The Oral Anticoagulants Over Warfarin - Assignment Example

How Efficient Are The Oral Anticoagulants Over Warfarin? Warfarin is a commonly used anticoagulant in the treatment of thrombosis, which is the formation of the blood clots in the blood vessels, but it can again be used as the anticoagulant in the treatment of thromboembolism, the migration of clots after formation to other parts of the body. Since the discovery of warfarin, it has been adapted by clinicians all over the world in the treatment of various conditions other than those named above. Despite the effectiveness of treatment established by the earlier clinicians, warfarin has been found to be ineffective due to a variety of reasons. These issues have posed questions on the efficiency and effectiveness of warfarin as a drug. With the inefficiency of warfarin, the researcher came up with new oral anticoagulants like dabigatran, Apixaban, and rivaroxaban in the treatment of patients with non-valvular AF. It`s for these reasons that majority of clinicians are starting to dispute the use of warfarin as a medical anticoagulant against various conditions it is thought to cure. This therapy has been found to have diverse side effects on patients forcing medical researchers to find alternative ways of treating the conditions and also improving on the use warfarin[Pha06]. Research conducted on the efficacy of the new oral anticoagulants administered to patients with AF indicated that the new oral anticoagulants reduced the risk of a stroke and systemic embolism as compared to warfarin.The research also established that the new oral anticoagulants were associated with reduced risks for secondary outcomes. These included hemorrhagic stroke, ischemic and unidentified stroke and vascular mortality. This proved that the new oral anticoagulants were more effective than warfarin[Con09]. The first side effect attributed to administration of warfarin is excessive bleeding in patients it is administered to. According to surveys conducted by medical researchers, reports indicated that major and fatal bleeding has been observed in patients. 1.3% of patients have died whereas 7.2% of the patients have bled severely. Warfarin is a blood thinner medicine that reduces the chances of blood clots forming inside the blood vessels[Ans10].It has also been established that some medications administered to increase bleeding in patients can be major causes of failure in warfarin. These include any medication involving heparin and non-steroidal anti-inflammatory drugs. On the other side, administration the new oral anticoagulants have been found to reduce the risk intracranial bleeding. Patients using the new oral anticoagulants need not be monitored for bleeding. For instance, Japanese studies indicated that administration of edoxaban, a new Xa inhibitor, worked best to reduce the risk of bleeding compared to warfarin. The new oral anticoagulants have also been suspected to increase the risk of gastrointestinal bleeding. Despite this fact, research doctors have advocated for the use of the new oral anticoagulants for long term anticoagulation therapy against AF patients as compared to warfarin[Cor12]. Warfarin has also been disputed by other clinicians due to the fact that has numerous and fatal complications; for instance pregnancy. Its administration to pregnant women has been established to have birth complications. Its administration during the trimester has been established to have diverse effects on the nervous system and the eyes. It may also be passed to the fetus through the placenta, causing excessive bleeding of the fetus. Its administration to pregnant women has been found to result in instant abortion, stillbirth and preterm birth. As explained earlier, some patients can be unfit for the administration of warfarin. In event of this, the new oral anticoagulants are deemed fit for such patients. It is only necessary that such patients stick to the prescribed dosage since skipping the new oral anticoagulants dosages may result in a stroke. Warfarin is also rendered ineffective with some food components. Researchers have found that some types of vitamins inhibit the proper action of warfarin in the body. Some foods deemed to contain vitamin K1, for instance, leaf vegetables, have been found to reverse the actions of warfarin. For instance, in patients with chronic kidney diseases, vitamin K1 is administered. This has been found to treat patients with the kidney disease but increases the risk of excessive bleeding among these patients. Vitamin K1 is attributed to a reduction in the risk of stroke and also reduction in thromboembolism in chronic kidney diseases. Therefore, clinical guidelines advise against the use of warfarin in such patients. As mentioned earlier, the new oral anticoagulants are recommended in instances where warfarin cannot be administered. In this case, such patients can only be treated using the new oral anticoagulants. Reversing the effects of warfarin has also been a difficult endeavor for clinicians. For instance, administration of vitamin K1 to restore coagulation has been found to take long, at least 24 hours, to reverse the actions of warfarin. This is not a good when it comes to overdose in the administration of warfarin and wrong administration. Such instances may lead to the death of patients or excessive bleeding. On the other hand, the action new oral anticoagulants in the body; dabigatran, in this case, can be reversed using hemodialysis. This method works to remove dabigatran from the body in 3 hours hence it can be used to treat dabigatran toxicity. Dabigatran, rivaroxaban, and apixaban are eliminated from the body through the renal system. Before their administration, clinicians are advised to diagnose and ascertain the patient's creatinine clearance using the Cockcroft-Gault formula. This will help in determining the dosage requirement for various patients. In warfarin administration, there is no agreed mechanism of administering the dosages to patients. The drug has been in use for 60 years yet clinicians do not have a clear basis for determining the right amount of the drug to be administered to patients. Various factors that inhibit the function of warfarin have been identified and they vary from patient to patient. This makes it difficult for clinicians to ascertain the correct dosage for various patients. This is one of the reasons that make warfarin less effective and more dangerous compared to the new oral anticoagulants[Ken14]. All the above arguments present evidence against the use of warfarin. It limitations has made it ineffective for clinical use but despite this, it is still used by clinicians all over the world since there is no established cure for the conditions it treats. New oral anticoagulants, on the other hand, have been found to have lesser flaws and are more effective in treating patients with nonvalvular AF regardless of their underlying conditions. Work Cited Pha06: , (1), Con09: , (2), Ans10: , (3), Cor12: , (4), Ken14: , (5), Read More