Review of the best according to the editors. About the selection criteria. The the material is subjective, is not advertising and is not serves as a guide to the purchase. Before purchase is needed consultation with a specialist.
This review will focus on medicines that are in everyday life. called “blood thinners.” In RuNet there are numerous materials on this subject in which you can find information on a variety of tools. These articles describe a variety of medicines that are not only for improving fluidity, that is, blood rheology, but also are folk remedies. Provides information on substances received from living structures (hirudin), about thinning medications for treatment varicose veins based on plant components. Such a “free the premise “of all these numerous, various means, biological preparations and plant extracts in a group “blood thinners” is not entirely correct.
In fact, there is a fairly limited amount medicines with proven effectiveness and systemic effect, which belong to the category of so-called disaggregants, or improving the rheological properties of blood (improving it fluidity).
- A little about the density of blood and its rheological properties
- Rating of the best blood thinners
- Acetylsalicylic acid (Cardiomagnyl, Thrombo-Ass, ASA – Cardio, Aspirin-Cardio)
- About enteric forms and systemic action
- Pros and Cons of ASK
- Curantyl (dipyridamole)
- Pros and cons
- Plavix, Deplatt, Zilt, Clopigrant, Lopirel, Egithrombe (clopidogrel)
- Pros and cons
- Trental, Agapurin, Wasonite (pentoxifylline)
- Pros and cons
- Wessel Douai F, Angioflux (sulodexide)
- Pros and cons
A little about the density of blood and its rheological properties
But before proceeding with the description of disaggregants – these important prophylactically diluting drugs blood and saved hundreds of thousands of lives, you need to understand what is “deterioration of fluidity” of the blood, and how such blood differs from “thick blood.”
There is such a simple laboratory indicator as hematocrit. Hematocrit is called the percentage, volume ratio between the liquid part of the blood, or its plasma, and the shaped cells elements. The greater this ratio, the thicker the blood. This density may arise due to an absolute factor, for example, an excess multiplication of all blood cells with a normal amount of plasma (true polycythemia, or Wakez disease).
But much more often the hematocrit rises due to a decrease the amount of liquid part of the blood is called relative. For example, it’s a severe intestinal infection with repeated diarrhea and vomiting, when blood coagulates due to fluid loss. It happens and physiological dehydration. For example, long heavy physical labor in a dry, hot climate and intense sweating.
Does blood thicken during these processes? Of course, it is thickening. Are needed Is there a blood thinner in this case? Of course not are needed. It is enough to restore the balance of the liquid that was changed, and blood will acquire lost rheological properties. What then are called drugs that dilute it? These are funds from two groups: anticoagulants and antiplatelet agents.
- Anticoagulants, or drugs that inhibit processes blood coagulation, are prescribed only by a doctor, and are not sold in pharmacy without a prescription. These include some tabletted drugs, for example Warfarin, Phenylin. But much more often used such funds that are administered subcutaneously. This is heparin and its modifications that are more modern low molecular weight fractions, for example, Fraxiparin. Since these funds can cause a significant amount in self-medication side effects then in this review these drugs will not be considered.
- Preparations from the group of disaggregants (thinning) reduce the adhesion of blood cells to each other (reduce them aggregation, and, above all, platelets). They warn the formation of so-called sludge, or columns of blood cells, which are the “embryos” of blood clots. As you know, thrombosis lies at the heart of vascular catastrophes leading to death, such as heart attack and stroke.
Therefore, general indications for the appointment of diluents there will be an increased risk of thrombosis, the presence of progressive varicose veins, individual forms of hypertension with high risk of heart attack and stroke, atherosclerosis and increased plasma cholesterol concentration. Separate indication for prescribing disaggregants is a common increased risk of developing heart attack and stroke in the population. So, the male population of large overwhelming majority of Russian cities after 45 years of age has such a risk, so if a man over 45 has a tendency to sedentary work, excessive body weight, he has bad habits and especially smoking, then he is shown a reception disaggregants.
In world practice, not many drugs are known from this groups that have proven effectiveness, but each is tested for many years by tens of thousands of volunteers and patients with a variety of pathologies, It was they who entered the rating. Opens his well-known drug like acetylsalicylic acid, in colloquially called by one of the oldest trading names – “Aspirin”.
Rating of the best blood thinners
|Nomination||a place||Name of product||minimum price|
|Rating of the best blood thinners||1||Acetylsalicylic acid (Cardiomagnyl, Thrombo-Ass, ASA – Cardio, Aspirin-Cardio)||117 rub|
|2||Curantyl (dipyridamole)||525 rub|
|3||Plavix, Deplatt, Zilt, Clopigrant, Lopirel, Egithrombe (clopidogrel)||947 rub|
|4||Trental, Agapurin, Wasonite (pentoxifylline)||144 rub|
|5||Wessel Douai F, Angioflux (sulodexide)||2 351 rub.|
Acetylsalicylic acid (Cardiomagnyl, Thrombo-Ass, ASA – Cardio, Aspirin-Cardio)
Acetylsalicylic acid is the progenitor of a large and very an important group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). The first word – “non-steroidal” – means that they have nothing to do with steroid hormones that have the most powerful abilities suppress inflammation.
Acetylsalicylic acid is an artificially enhanced natural a variety of one of the salicylates that was used in medicine previously as an antipyretic. Most it was contained in the bark of white willow (salicin); there is it in raspberries. The artificial molecule of acetylsalicylic acid is much stronger substance.
During the 20th century, many different means were created from this group, such as Ibuprofen, Meloxicam, Nimesulide and others. All of them, to varying degrees, are able to suppress the development of inflammation, reduce pain, have an antipyretic effect.
Along the way, it turned out that low doses of acetylsalicylic acid, which are not high enough to reduce heat, at planned and long-term use contributes to a significant reduce the risk of thrombosis and heart attacks and ischemic strokes. It was found that after a single dose acetylsalicylic acid blood flow improvement effect persists for a whole week.
The mechanism of action is based on the blocking of the enzyme. cyclooxygenase type 1 (COX – 1). This causes the cascade to start. processes: the synthesis of prostaglandins, thromboxane and others is blocked substances, and this leads to a decrease in aggregation, or stickiness platelets among themselves, and suppressing the induction of thrombosis. The establishment of this fact was a real gift for medicine. IN for decades, much practical material has accumulated, and in currently the minimum dosage that is capable of daily intake to reduce the risk of developing vascular accidents is 75mg. The standard dosage ranges around 100 mg per in terms of acetylsalicylic acid.
All cardiac “aspirins” are designed for long-term use, and consumed before meals with plenty of fluids. The main indications, as mentioned above, are considered to be the prevention of acute myocardial infarction, secondary prevention of heart attacks and ischemic strokes. Cardiac Aspirin Used for Prevention thromboembolic complications after surgery and various vascular interventions. Indications for the use of ASA (acetylsalicylic acid) are very broad. This is diabetes and obesity, angina pectoris and the risk of developing vascular accidents. It is used in the presence of bad habits, and especially with smoking The use of acetylsalicylic acid improves condition of coronary implants, various transplants, including number, after valve operations and after coronary artery shunting.
However, acetylsalicylic acid even in such small doses, but used for a long time, has its contraindications. First of all, this is an exacerbation of ulcerative diseases of the stomach and duodenum, as well as erosive gastritis. it conditions with a high risk of gastrointestinal bleeding, low blood coagulability, hemorrhagic diathesis. In no case you can not use it during pregnancy, during lactation and to persons under the age of 18. Children taking acetylsalicylic acid is strictly prohibited due to possible development Reye’s syndrome is fatal, therefore, children with the goal antipyretics and reduction of inflammatory symptoms are prescribed or ibuprofen or paracetamol preparations.
Aspirin is contraindicated in the so-called aspirin asthma, and recurrent nasal polyposis. You can not use it with severe renal and liver failure. There is also a large number of relative contraindications, such as gout, hyperuricemia, condition before surgery due to possible development of bleeding.
Overdose symptoms may also occur, and they are especially dangerous in the elderly, therefore, prescribe ASA for long use should only be a doctor.
Currently, pharmacies can purchase a large number varieties of acetylsalicylic acid in a low dosage so called “cardiac aspirins.” So, if we consider a popular dosage of 100 mg, then one package, designed for a monthly intake, and consisting of 30 tablets, has a different, but low cost, depending on the manufacturer. So:
- ASK – Cardio, a domestic manufacturer of Medisorb, will cost an average of 50 rubles;
- Aspikor domestic producer ZAO Vertex in the same dosage and in the same amount costs 56 rubles;
- Cardiask manufactured by Canonfarm Production CJSC – 60 rubles.
As you can see, the price of domestic medicines is about the same. If a consider an imported drug, for example, Thrombo – ACC in the same dosage and in the amount of 28 tablets produced by the Austrian firm Lannacher, then its cost will be the same – 52 rubles. behind packaging.
About enteric forms and systemic action
Currently, they are very popular in the pharmaceutical market. called “enteric forms” of acetylsalicylic acid, or blood-thinning pills that bypass the stomach, and dissolve only in the small intestine. This fact is achieved. the addition of a special shell for tablets acetylsalicylic acid, which consists of magnesium hydroxide. Everyone knows that this the base is part of antacids, and just helps acetylsalicylic acid bypass the acidic environment of the stomach.
According to manufacturers, this device helps reduce the risk of the most common side symptom – the occurrence of an increased risk of gastric bleeding, exacerbation of ulcerative and erosive processes in gastric mucosa.
But in fact, it has long been proven that ulcerogenic, or gastric ulcer activating action acetylsalicylic acid is a systemic effect. it means that ASA harms the stomach not only locally, being inside him, but having already completely gone through the entire gastrointestinal tract, and sucked into the blood. And that means betting only on local cover when taking acetylsalicylic acid will be insufficient way to protect against systemic side effects, and that’s can be regarded as an element of an advertising strategy.
Perhaps the most famous drug of this the group will be Cardiomagnyl. You can also name tools such as Thrombital, Thrombomag, Phasostabil and so on. The price of these pills slightly higher than just tablets without a protective, acid resistant shell. So, a pack of Cardiomagnyl in 30 tablets of 75 mg each, calculated per month is, on average, 135 rubles.
Pros and Cons of ASK
Whatever the disadvantages of acetylsalicylic acid, anyway, the benefits far outweigh all kinds of flaws (of course in if the appointment and administration of the drug is under medical supervision). The main disadvantages will be absolute contraindications – acute gastric ulcer, risk the occurrence of gastrointestinal bleeding, childhood and all those conditions that were given above. Perhaps development bleeding if aspirin is administered tooth extraction and other manipulations. There is a fact of development aspirin asthma, individual intolerance to this remedy and other conditions.
But still, taking into account all the contraindications and side effects, all of these cases are significantly less than the number patients in need of reducing the risk of heart attack and stroke, which includes millions of people. Pills acetylsalicylic acid are inexpensive, well tolerated the vast majority of patients, and are considered means, really prolonging life in the presence of cardiovascular risk factors.
Dipyridamole, or Curantil – the second medicine from the group blood thinners with proven efficacy but it is prescribed less frequently than acetylsalicylic acid. And this unjustified: ASK advertising is so strong that it “pushed into the shadows” dipyridamole. Curantyl not only improves rheological properties blood and helps to reduce platelet aggregation, but also has other systemic hemodynamic effects. So he dilates blood vessels, and especially this effect is noticeable on small coronary arteries and arterioles.
As a result, Courantil reduces the overall peripheral vascular resistance, helps lower blood pressure pressure, and additionally contributes to the normalization of venous outflow. In the brain, it reduces the resistance of cerebral vessels, and in obstetrics and gynecology is able to improve placental blood flow, especially in various threatening conditions. Besides of this, dipyridamole activates the immune system, and increases activity interferon induction systems. As a result, this substance has not only antiaggregational, but also angioprotective and immunomodulatory effect.
Curantyl is prescribed in the same way as acetylsalicylic acid, with the goal of preventing arterial and venous thrombosis, thromboembolism, with impaired microcirculation. Special indication there will be prevention of pulmonary embolism after surgical interventions after valve operations. Courantil is shown as means for stopping placental insufficiency with complicated pregnancy. For prevention, you must take Curantil in a dosage of 75 to 225 mg per day, dividing the daily dose in several doses. Means as a vasodilator and for prevention it is used for a long time, under the supervision of a doctor.
Separate indication, and very unusual for thinners means will be the prevention of influenza and respiratory viral infections. For this, the drugs are used in the minimum dosage according to 25 mg 2 times a day (in one day). This dosage is applied only once a week, for a month. That is, per month a person consumes Curantyl for only 4 days.
The famous German pharmaceutical company releases Curantil. Berlin Chemie, Menarini Group. Pack of 120 tablets in a dosage of 25 mg will cost an average of 650 rubles. If assigned to a patient the minimum dosage is 75 mg per day, then this amount is enough about a month and a half. If necessary, it will be twice as much high dosage, this package may be enough only for one month or less. There are domestic counterparts, for example, dipyridamole, which is produced by a pharmaceutical company Obolenskoe. So, 120 tablets can be purchased at the price of only for 387 rubles. This, of course, is a much smaller amount.
Pros and cons
The advantage of dipyridamole, or Curantyl, will be the ability to apply it as a vasodilator (vasodilator), which is devoid of acetylsalicylic acid. It should be prescribed to patients. several times a day, flexibility with respect to daily allowance is important doses that can range from 75 to 600 mg. Important opportunity its use in obstetrics and gynecology, including not only with preventive, but with a therapeutic purpose.
Few experts prescribe dipyridamole as antiviral or immunomodulatory substance, but nonetheless Certain experience has been gained in its use during periods of the epidemic SARS and flu. Of course, dipyridamole is considered more expensive. drug than numerous trade names for acetylsalicylic acids, but at the same time it also “works” not only how disaggregant. It not only affects the rheological properties of blood, but also improves hemodynamics in the cardiac, brain and placental vessels.
Of course, dipyridamole also has contraindications, for example acute heart attack, unstable angina pectoris, severe forms of hypertension and hypotension, hemorrhagic disorders, and childhood. Especially you need to remember that coffee and tea, which are used in significant amounts weaken the effect of exposure Curantila.
Plavix, Deplatt, Zilt, Clopigrant, Lopirel, Egithrombe (clopidogrel)
Plavix, or clopidogrel (INN), will be a serious medicine, and also applies to disaggregants, as well as ASA, thinning the blood. Naturally, the higher power and strength of Plavix never push ASK into second and third positions. The fact is that aspirin is immeasurably cheaper and also widely distributed and safe to use. Clopidogrel has a completely different mechanism. actions associated with an irreversible change in specific receptors on platelets.
Clopidogrel was first introduced into clinical practice in 1997 year, and at first it was used in quite serious cardiological patients. Indications for use were acute coronary syndrome, including with changes in the ECG, percutaneous coronary intervention, and other cases. High enough efficacy has been observed in patients with unstable angina pectoris. In an outpatient clinic, it is important that a large experience with clopidogrel in patients with atherosclerosis, in particularly with chronic cerebral ischemia. Therefore in if the patient has resistance to antithrombotic therapy, and aspirin alone does not cope with improvement of the rheological properties of blood, then clopidogrel is medicine of choice or expansion of the scheme, especially if the cardiovascular system is already compromised by what happened myocardial infarction or the presence of unstable angina.
One of the important advantages of clopidogrel over acetylsalicylic acid will be able to prescribe it to patients with unstable angina pectoris, which is based on vasospasm, while aspirin is the diagnosis is contraindicated.
It is important that Plavix can be used not only in the form of monotherapy, but also with acetylsalicylic acid, and even in composition of triple antithrombotic therapy. So Plavix was effective in such a complex combination as sharing it use with acetylsalicylic acid and anticoagulant Warfarin. This combination may be necessary in patients with atrial fibrillation and with prosthetic heart valves.
Usually, the standard dosage of Plavix in patients with atherosclerotic changes in blood vessels, which recently had suffered a heart attack or stroke, is 75 mg per day. Already on at this dosage there is a statistically significant reduction in risk recurrent heart attack, stroke, and cardiovascular death. At It is important that the use of clopidogrel has been associated with significantly lower incidence of side effects such as the development of gastrointestinal bleeding, compared with acetylsalicylic acid. Take Plavix necessary for a long time.
Currently, the pharmacy can be purchased as original liquefaction drugs – Plavix manufactured by Sanofi, and generics. So, a package of Plavix with a dosage of 75 mg, calculated on a monthly course, on average costs 990 rubles. Indian generics such as clapitax will cost half cheaper. Clopidogrel Canon manufactured by domestic pharmaceutical company ZAO Canonfarm Production, will cost 340 rubles. Perhaps this is one of the cheapest analogues on domestic market.
Pros and cons
First of all, you need to remember that Plavix, or any clopidogrel is a serious medicine for compromised patients. You should not take it just relatively young people low in physical activity, overweight and harmful habits. In this case, it’s quite possible to cope with prevention acetylsalicylic acid. But for patients with the development of systemic atherothrombosis, after various heart operations heart attack or stroke, necessary for secondary prevention use this medicine.
A very big plus will be the fact that it is combined with acetylsalicylic acid, and to such persons it significantly reduces the risk of heart death when compared with a separate administration of ASA. The minus of clopidogrel is considered a fairly high cost, and the need against the background of its use to regularly monitor regarding various bleeding options as well monitor the functional state of the liver.
Trental, Agapurin, Wasonite (pentoxifylline)
Previous drugs such as acetylsalicylic acid and clopidogrel, regulated blood coagulation, changing properties platelet count. Trental (pentoxifylline according to INN) has a thinning effect action in several ways. It reduces platelet aggregation, but it also affects red blood cells. It improves their ability to deformation tolerance, especially when penetrating small capillaries. Pentoxifylline reduces the concentration of fibrinogen, which regulates the rate of blood clots, reduces the ability adhesion, or adhesion, of white blood cells to the inner vascular wall. Therefore, as a result, the normalization of rheological blood properties complemented by improved microcirculation and vasodilating, or vasodilating action.
Pentoxifylline is an active substance, and the mechanism the effects of this compound are associated with decreased activity phosphodiesterase (PDE) in vascular muscle cells and elements blood.
The great value of this drug is to improve capillary blood flow, or microcirculation, in areas with their violation. Therefore, pentoxifylline and its variants are indicated for all vascular diseases that are accompanied by disorders capillary blood flow.
These are various trophic ulcers on the legs, including diabetes and severe stages of varicose veins. Pentoxifylline is prescribed for diabetic angiopathy, with various disorders of the brain blood circulation. Most often, Trental is prescribed to patients with cerebral atherosclerosis, but can also be used in individuals with post-traumatic and alcoholic encephalopathy, with dizziness, with memory impairment. Trental shown in case of development sensorineural hearing loss, with circulatory disorders in retina. He is prescribed in outpatient practice in tablets. 100 mg three times a day, followed by a gradual increase in dose twice. In this case, pentoxifylline more than 1200 mg should not be used. per day in three doses, that is, a single dose should not exceed 400 mg Low-dose treatment is also possible, especially in patients with low blood pressure. After all, Trental has a vasodilator effect, and can independently lower blood pressure. The duration of the course is set by the doctor.
Produces Trental manufacturer Sanofi-Aventis, and medium the cost of packing 60 tablets of 100 mg is 530 rubles. With an average dosage of 600 mg per day, such a package is enough only for 10 days, and the monthly cost of the course will be about 1600 rubles. Therefore, Trental can not be considered a cheap tool.
Pros and cons
A big plus of Trental will be the ability to influence microvasculature. This allows him to cope with a rather complex conditions in which various trophic disorders. However, it is contraindicated in massive bleeding, various acute processes, such as heart attack and stroke, retinal hemorrhage. Do not use it with pregnant women, nursing mothers and children. There are many relative contraindications. One of them is joint Trental administration with clopidogrel, and acetylsalicylic acid. Unlike its predecessors, this tool does not apply with other drugs from the genus of disaggregants. But despite everything cons, pentoxifylline is indispensable in large groups of patients who in old age suffer from a chronic disorder peripheral circulation, whether it is the lower extremities, the retina eyes or microvasculature of the brain.
Wessel Douai F, Angioflux (sulodexide)
Perhaps the last in a cohort of “big” liquefaction drugs blood can be called Wessel Duet F. Its active substance is sulodexide, and analogues in the pharmaceutical domestic market almost never occurs. You can still find Angioflux, which produced by the domestic company Sotex Pharma. Original Wessel Douai F is produced by the Italian pharmaceutical company Alpha Wasserman. This blood thinner medicine is available in ampoules, in capsules of 250 units each, and a package of sulodexide 50 capsules will cost from 2700 rubles.
As you can see, sulodexide is very expensive for the average Russian consumer of drugs. Why is he so dear? Sulodexide improves rheological properties of blood, reduces blood clots, protects vessels and simultaneously possesses anticoagulant action. That is, he acts not only on the cellular, platelet link, but also on plasma factors of hemostasis. Sulodexide is natural natural compound of animal origin. He stands out from the mucous membrane of the porcine intestine. Main component protrudes low molecular weight heparin fraction. So Thus, the drug does not affect platelets, not their tendency to thrombosis, and exhibits a special affinity for certain coagulation factors: antithrombin III and heparin cofactor II.
Therefore, the antithrombotic effect is realized by completely different in ways other than acetylsalicylic acid, clopidogrel, and pentoxifylline. X coagulation factor activation inhibited plasma, increases the secretion of prostacyclin and decreases the amount fibrinogen. Because Wessel Douai F is expensive: he acts gently, but at once to several links of hemostasis, both cellular and plasma. It’s a disaggregant and anticoagulant in one bottle. ”
Sulodexide is indicated for use in patients at high risk. thrombosis: after a heart attack, with various forms hypertensive encephalopathy complicated by atherosclerosis. Wessel Douai F is indicated in complex therapy for patients with diabetes mellitus, hypertension and vascular dementia. With success this tool is used in patients with occlusive lesions arterial vessels of the lower extremities on the background of atherosclerosis and diabetes. A very important indication is the treatment of special complications called heparin-induced thrombocytopenia. It sometimes develops after taking heparin.
Initially, the drug is usually administered intramuscularly for 2-3 weeks, and then inside, one capsule per day between meals within a month.
Pros and cons
A plus of Wessel Duet F can be considered its effectiveness and good portability. Overdoses are rare, side effects weakly expressed. Most often different functional disorders of the gastrointestinal organs a path, and allergic reactions. This drug is under observation. the doctor can be used in pregnant women and in nursing mothers, except 1 trimester of pregnancy. A strict contraindication can be considered hypersensitivity and increased bleeding, or manifestation hemorrhagic diathesis. Perhaps such a softness of action and a small number of contraindications are dictated by natural the origin of sulodexide. Currently Wessel Douai F is an indispensable means of complex therapy of various thrombotic conditions, peripheral disorders blood circulation, especially in cases where the patient has intolerance or contraindications to the appointment of acetylsalicylic acid and its analogues.
In conclusion, we can say that this rating of funds for improvements in blood rheological properties were not included drugs obtained from leeches, agents for the treatment of varicose veins diseases based on hesperidin, diosmin and escin, many medicinal products based on medicinal plants and folk blood thinners. This rating includes only those drugs that have proven worldwide effectiveness and a large clinical base of research, while providing systemic action.
Attention! This rating is subjective, not advertising and does not serve as a guide to the purchase. Before the purchase consultation with a specialist is necessary.