Summary: EP44 - Clots And Drugs

**EP44: Clots And Drugs** Welcome to Dr. Warwick's podcast channel. Warwick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warwick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warwick Bishop, and I'd like to welcome you to my consulting room. Today, I'd like to respond to a Facebook question, and the Facebook question was about some drugs, in particular, warfarin and Prasugrel. Well, I'm going to separate those down into the sort of agents that we use to stop clots forming in the body. If you're really interested in this, then in about six months' time, I will have a new book on the market about atrial fibrillation. Atrial fibrillation is really important and central in terms of understanding how we thin the blood. But until that book is available, or if you want something a little bit simpler, I'm going to cover it today. What I'd like you to think about is that when a clot forms in the body, there are two main drivers. One of them is the small sticky components in the blood called platelets, and the other is the chemicals or the proteins that float around in the blood called the coagulation cascade. In terms of the platelets in the bloodstream, these are the things that we don't want to clump together, and we use agents like aspirin, clopidogrel, ticagrelor, and Prasugrel. These are all called antiplatelet drugs, and they stop these small particles from clumping together. These are mostly used in the arterial system, such as in stents, for example. People who have had carotid artery problems or those with coronary artery disease get the antiplatelet agents. The other group of agents that we use are to thin the blood through the coagulation cascade or by affecting the proteins involved in clot formation. Historically, the most widely used and known is warfarin. We've all heard of warfarin, and that is a blood thinner. But there are new agents on the market. These new agents are called NOACs, which stands for non-vitamin K dependent oral anticoagulants. So these are blood thinners that affect the coagulation cascade in a way that's different from warfarin. They target particular parts of that coagulation cascade. There are three main agents that we currently have available. The first is rivaroxaban, also called Xarelto. The next is one called Pradaxa, which is the trade name; the generic name is dabigatran. And the last one is apixaban, which is the generic name; the trade name is Eliquis. So when it comes to keeping the blood thin, we either stop clots from forming by dealing with the platelets and using antiplatelet agents, or we keep the blood thin by dealing with the proteins in the blood that form clots called anticoagulants. The drugs that we use to deal with that are called anticoagulants. I hope that explains a bit. I hope that shows you where those things fit in. And hopefully for the Facebook group, it makes a bit of sense because there were some questions around that. Thank you for joining me. And as always, I wish you good health. Goodbye. You have been listening to another podcast from Dr. Warwick. Visit his website at drwarwickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.