warfarinfo

Warfarin Institute of America

DEDICATED TO YOUR HEALTH SINCE 2000

WHY DO I HAVE TO TAKE WARFARIN (Coumadin, Jantoven) WHEN SOMEONE ELSE TAKES ASPIRIN FOR A BLOOD THINNER?

There are two blood clotting systems. One involves the blood cells called platelets. These are actually little balls which roll around in the blood. Ordinarily, they roll over each other and the other blood cells. As you can imagine, it is very hard to build a stack of balls. But when they come to an area where a clot is needed, they grow little braces that are like legs. These legs allow them to stick together and form a stack.

What causes platelets to start clots? Usually it is something in an artery. Blood in an artery is under high pressure because it has only recently been pumped out of the heart. When there is something plugging an artery (usually cholesterol) this is like putting your thumb over a garden hose. (The pressure increases more and there are high shear forces on the platelets.)

Aspirin works by preventing the platelets from growing legs. So, aspirin is the best choice for preventing clots which will start in arteries. A heart attack is a good example.

The second clotting system involves thrombin. Think of thrombin as being like string. It forms a web and captures platelets to help form a clot.

What causes thrombin to start clots. This usually happens in veins where the blood flow is under lower pressure and moving more slowly than in the arteries. Think of an eddy current in a stream as an example of stagnation. In the blood, the swirling action can lead to thrombin forming a clot.

warfarin (Coumadin, Jantoven) is the choice when the clot is due to stagnation. The two best examples are deep vein thrombosis (DVT) and atrial fibrillation (a-fib).

There is some crossover between the two systems. Aspirin is the best choice for preventing a heart attack and for preventing strokes which would arise from blocked carotid arteries. Because thrombin will wrap itself around this type of clots, warfarin (Coumadin, Jantoven) will give some minor protection. One exception, is that warfarin (Coumadin, Jantoven) is usually prescribed for several weeks or months after a heart attack when the risk of re-clotting is extremely high. warfarin (Coumadin, Jantoven) is prescribed to prevent strokes arising from the irregular heart rhythm known as atrial fibrillation and from DVTs forming (usually in the legs).

Before you complain to your doctor about some complication of warfarin (Coumadin, Jantoven) and ask to be switched to aspirin, you should know that you may be giving up as much as 60% of your protection from a stroke. Think carefully about the risks and benefits of both before you make your decision.

What about Ticlid (ticlopidine), Plavix (clopidogrel) and Pletal (cilostazol)? These are similar to aspirin. Ticlid is not much used in the United States any more because it offers little advantage over aspirin and has more serious side effects. Plavix has an advantage over aspirin when used right after stents are put in coronary (heart) arteries. However, its high price makes it questionable as to whether or not it is cost-effective compared to aspirin. Pletal may be the best of the bunch, but we will probably never know the final answer. It did well at preventing arterial clots in one study, however, it has little time left before the patent runs out and it can be marketed by generic companies. Because of the expense involved in doing studies to get the Food and Drug Administration to widen its official uses, the company is not willing to do these with such a short time left for exclusive marketing.

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Last updated June 14, 2007