5 best blood thinners
This review will be devoted to drugs that are called “blood thinners” in everyday life. In RuNet there are numerous materials on this topic, in which you can find information about a variety of means. Such articles describe a variety of drugs that are not only designed to improve fluidity, that is, the rheology of blood, but also are folk remedies. Information is provided on substances derived from living structures (hirudin), thinning drugs for the treatment of varicose veins based on herbal ingredients. Such a “free place” of all these numerous, very different means, biological preparations and plant extracts in the “blood thinning” group is not entirely correct.
In fact, there is a fairly limited number of drugs that have proven efficacy and systemic effects that fall into the category of so-called antiplatelet agents, or that improve the rheological properties of blood (which improves its fluidity).
A little about blood density and its rheological properties
But before proceeding to the description of disaggregants - these preventively important drugs that thin the blood and save hundreds of thousands of lives, you need to understand what is the "deterioration of the fluidity" of blood, and how this blood differs from "thick blood."
There is such a simple laboratory indicator as hematocrit. Hematocrit refers to the percentage, volume ratio between the liquid part of the blood, or its plasma, and the cells, the formed elements. Than this ratio is more than blood is thicker. This density can occur due to the absolute factor, for example, excessive reproduction of all blood cells with a normal amount of plasma (true polycythemia, or Vaquez disease).
But more often the hematocrit rises due to a decrease in the amount of the liquid part of the blood and is called relative. For example, it is a severe intestinal infection with repeated diarrhea and vomiting, when the blood thickens due to fluid loss. It happens and physiological dehydration. For example, prolonged heavy physical work in a dry, hot climate and intense sweating.
Does the blood thicken during these processes? Of course, thickens. Does this case require blood thinners? Of course, not needed. It is enough to restore the balance of the fluid that has been changed, and the blood will acquire the lost rheological properties. What then drugs are called means, diluting it? This means of two groups: anticoagulants and antiplatelet agents.
- Anticoagulants, or drugs that inhibit blood clotting processes, are prescribed only by a doctor, and are not sold in a pharmacy without a prescription. These include some tablet preparations, for example Warfarin, Fenilin. But much more often used such funds that are prescribed subcutaneously. These are heparin and its modifications that belong to more modern low-molecular fractions, for example, Fraxiparin.Since these drugs can cause a significant amount of side effects during self-treatment, these drugs will not be considered in this review.
- Preparations from the group of antiplatelet agents (thinning) reduce the stickiness of blood cells between themselves (reduce their aggregation, and, above all, platelets). They prevent the formation of so-called sludge, or columns of blood cells, which are the "embryos" of blood clots. Thrombosis is known to underlie vascular catastrophes resulting in death, such as heart attack and stroke.
Therefore, the general indications for the appointment of thinning agents there will be an increased risk of thrombosis, the presence of progressive varicose disease, certain forms of hypertension with a high risk of heart attack and stroke, atherosclerosis, and elevated plasma cholesterol concentration. A separate indication for the appointment of antiplatelet agents is the overall increased risk of heart attack and stroke in the population. Thus, the overwhelming majority of the male population of large cities in Russia after the age of 45 has such a risk, so if a man over 45 has a tendency to sit down, overweight, he has bad habits and especially smoking, then he is shown disaggregants.
In world practice, there are not so many drugs from this group that have proven efficacy, but each of them has been tested for many years on tens of thousands of volunteers and patients with very different pathologies. They were included in the rating. It is opened by such a well-known drug as acetylsalicylic acid, colloquially called by one of the oldest trade names - "Aspirin."
Ranking of the best blood thinners
| Nomination | a place | Name of product | minimum price |
| Ranking of the best blood thinners | 1 | Acetylsalicylic acid (Cardiomagnyl, Thromboc-Ass, ASA - Cardio, Aspirin-Cardio) | 117 ₽ |
| 2 | Curantil (dipyridamole) | 525 ₽ | |
| 3 | Plavix, Deplatt, Zilt, Klopigrant, Lopirel, Egitrombe (clopidogrel) | 947 ₽ | |
| 4 | Trental, Agapurin, Vazonit (pentoxifylline) | 144 ₽ | |
| 5 | Wessel Due F, Angioflux (sulodexide) | 2 351 ₽ |
Acetylsalicylic acid (Cardiomagnyl, Thromboc-Ass, ASA - Cardio, Aspirin-Cardio)
Rating: 4.9
Acetylsalicylic acid is the ancestor of a large and very important group of drugs, which is called non-steroidal anti-inflammatory drugs (NSAIDs). The first word, “nonsteroidal,” means that they have nothing to do with steroid hormones, which have the strongest ability to suppress inflammation.
Acetylsalicylic acid is an artificially enhanced natural variety of one of the salicylates, which was previously used in medicine as a febrifuge. Most of it was contained in the white willow bark (salicin), it is in raspberries. An artificial acetylsalicylic acid molecule is a much stronger substance.
During the 20th century, many different means of this group were created, such as Ibuprofen, Meloxicam, Nimesulide and others. All of them are capable of suppressing the development of inflammation to a varying degree, reduce pain, and have a fever-reducing effect.
Along the way, it turned out that low doses of acetylsalicylic acid, which are not high enough to reduce high temperature, with planned and long-term use, contribute to a significant reduction in the risk of thrombosis and the development of heart attacks and ischemic strokes. It was found that after a single dose of acetylsalicylic acid, the effect of improving blood flow remains for a whole week.
The mechanism of action is based on blocking the type 1 cyclooxygenase enzyme (COX - 1).This leads to the launch of a cascade of processes: the synthesis of prostaglandins, thromboxane and other substances is blocked, and this leads to a decrease in platelet aggregation or platelet adhesion among themselves, and inhibition of thrombosis induction. The establishment of this fact was a real gift for medicine. For decades, accumulated a large practical material, and now the minimum dosage that can, with daily intake, reduce the risk of developing vascular accidents is 75 mg. The standard dosage ranges around 100 mg in terms of acetylsalicylic acid.
All heart "aspirins" are designed for long-term use, and are consumed before meals with a large amount of liquid. The main indications, as mentioned above, are the prevention of acute myocardial infarction, secondary prevention of heart attacks and ischemic strokes. Cardiac "aspirin" is used to prevent thromboembolic complications after surgery and various interventions on the vessels. Indications for use of ASA (acetylsalicylic acid) are very wide. This diabetes and obesity, angina and the risk of vascular accidents. It is used in the presence of bad habits, and especially when smoking. The use of acetylsalicylic acid improves the condition of coronary implants, various transplants, including after valve operations and after coronary artery bypass surgery.
However, acetylsalicylic acid, even in such minor dosages, but used for a long time, has its contraindications. First of all, it is an exacerbation of gastric ulcer and duodenal ulcer, as well as erosive gastritis. These are states with a high risk of gastrointestinal bleeding, low blood clotting, hemorrhagic diathesis. In no case can not use it during pregnancy, lactation and persons under the age of 18 years. Children with acetylsalicylic acid are strictly prohibited due to the possible development of Ray's syndrome, or even death, so children with ipuprofen or paracetamol are prescribed for the purpose of anti-depression and inflammatory symptoms.
Aspirin is contraindicated in the so-called aspirin asthma, and recurrent nasal polyposis. It can not be used for severe renal and hepatic failure. There are also a large number of relative contraindications, such as gout, hyperuricemia, and a condition before operations due to the possible development of bleeding.
Overdose symptoms may also occur, and they are especially dangerous in the elderly, therefore, only a doctor should prescribe ASK for long-term use.
Currently, in pharmacies, you can buy a large number of acetylsalicylic acid in low dosage, the so-called "cardiac aspirins." So, if we consider the popular dosage of 100 mg, then one pack, designed for a monthly intake, and consisting of 30 tablets, has a different, but low cost, depending on the manufacturer. So:
- ASC - Cardio, domestic manufacturer Medisorb, will cost an average of 50 rubles;
- Aspikor domestic manufacturer JSC Vertex in the same dosage and in the same amount is 56 rubles;
- Cardiask manufactured by Kanonfarm Production Ltd. - 60 rubles.
As you can see, the price of domestic drugs is about the same. If we consider an imported drug, for example, Thromboc-ACC in the same dosage and in the amount of 28 tablets, produced by the Austrian company Lannaher, then its cost will be the same - 52 rubles. per pack.
On enteric forms and systemic effects
Currently, the so-called “enteric forms” of acetylsalicylic acid, or blood-thinning tablets, which bypass the stomach and dissolve only in the small intestine, are very popular in the pharmaceutical market.This fact is achieved by adding a special shell for acetylsalicylic acid tablets, which consists of magnesium hydroxide. Everyone knows that this base is part of antacid preparations, and simply helps acetylsalicylic acid to pass the acidic environment of the stomach.
According to manufacturers, such a device helps to reduce the risk of the most common adverse symptom - the emergence of an increased risk of gastric bleeding, exacerbation of ulcerative and erosive processes in the gastric mucosa.
But in fact, it has been proven for quite some time that an ulcerogenic, or activating gastric ulcer, effect of acetylsalicylic acid is a systemic effect. This means that ASA harms the stomach not only locally, being inside it, but having already passed through the entire gastrointestinal tract, and absorbed into the blood. This means that relying only on local cover while taking acetylsalicylic acid will not be an adequate way to protect against systemic side effects, and this can be regarded as an element of the advertising strategy.
Perhaps the most famous drug from this group will be Cardiomagnyl. You can also call such means as Trombital, Trombomeg, Phasostabil and so on. The price of these tablets is slightly higher than just tablets without a protective, acid-resistant coating. Thus, the packing of Cardio Magnetic in 30 tablets of 75 mg each, calculated for a month, is, on average, 135 rubles.
Pros and cons of ASC
Whatever the minuses of acetylsalicylic acid, anyway, the benefits far outweigh the various shortcomings (of course, if the prescription and administration of the drug is under medical supervision). The main disadvantages are absolute contraindications - acute gastric ulcer, the risk of gastrointestinal bleeding, childhood and all those conditions that were mentioned above. The development of bleeding is possible if a tooth extraction and other manipulations are performed while taking aspirin. There is a fact of development of aspirin asthma, individual intolerance to this remedy and other conditions.
Still, given all the contraindications and side effects, all of these cases are significantly less than the number of patients who need to reduce the risk of developing heart attack and stroke, which include millions of people. Acetylsalicylic acid tablets are inexpensive, well tolerated by the vast majority of patients, and are considered agents that really prolong life in the presence of cardiovascular risk factors.
Curantil (dipyridamole)
Rating: 4.8
Dipyridamole, or Curantil is the second drug from the group of antiplatelet agents for blood thinning with proven effectiveness, but it is prescribed less often than acetylsalicylic acid. And this is unjustified: the advertisement of ASA is so strong that it “pushed dipipyridamole into the shadow”. Curantil not only improves the rheological properties of blood and helps to reduce platelet aggregation, but also has other systemic hemodynamic effects. So, it dilates the vessels, and this effect is especially noticeable on the small coronary arteries and arterioles.
As a result, Curantil reduces overall peripheral vascular resistance, helps to lower blood 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 it can improve placental blood flow, especially in various threatening conditions. In addition, dipyridamole activates the immune system, and increases the activity of the interferon induction system. As a result, this substance has not only anti-aggregation, but also angioprotective and immunomodulatory effects.
Curantil is prescribed in the same way as acetylsalicylic acid in order to prevent arterial and venous thrombosis, thromboembolism, and microcirculation disorders. A special indication will be the prevention of pulmonary embolism after surgery, after valve operations. Curantil is shown as a means to relieve placental insufficiency in complicated pregnancy. For prevention, it is necessary to take Curantil in a dosage of 75 to 225 mg per day, dividing the daily dose into several doses. Means as expanding blood vessels and for the prevention is applied for a long time, under the supervision of a physician.
A separate indication, and very unusual for thinning agents, will be the prevention of influenza and respiratory viral infections. For this means is used in the minimum dosage of 25 mg 2 times a day (in one day). This dosage is applied only once a week for a month. That is, a month a person uses Curantil only for 4 days.
Curantil produces well-known German pharmaceutical company Berlin-Hemi, Menarini group. Packaging in 120 tablets with a dosage of 25 mg will cost an average of 650 rubles. If the patient is prescribed a minimum dosage of 75 mg per day, then this amount will last for about a month and a half. If a twice higher dosage is needed, then this package may last only one month or even less. There are also domestic analogues, for example, dipyridamole, which is produced by the pharmaceutical company Obolensky. So, 120 tablets can be purchased at a price of only 387 rubles. This is of course a much smaller amount.
Advantages and disadvantages
The advantage of dipyridamole, or Curantila, will be the possibility to use it as a vasodilator (vasodilator), which acetylsalicylic acid is deprived of. It should be prescribed to patients several times a day, flexibility is important in relation to the daily dose, which can vary from 75 to 600 mg. The possibility of using it in obstetrics and gynecology, including not only prophylactic, but also for medical purposes, is important.
Few of the experts designate dipyridamole as an antiviral or immunomodulatory substance, but, nevertheless, some experience has been gained of its use during periods of an epidemic of ARVI and flu. Of course, dipyridamole is considered a more expensive drug than the numerous trade names of acetylsalicylic acid, but at the same time it also “works” not only as a disaggregant. It not only affects the rheological properties of blood, but also improves hemodynamics in the heart, brain and placental vessels.
Of course, dipyridamole also has contraindications, such as acute heart attack, unstable angina, severe forms of hypertension and hypotension, hemorrhagic disorders, and childhood. Especially it is necessary to remember that coffee and tea, which are consumed in significant quantities, weaken the effect of Courantila.
Plavix, Deplatt, Zilt, Klopigrant, Lopirel, Egitrombe (clopidogrel)
Rating: 4.7
Plavix, or clopidogrel (INN), will be a serious medicine, and also applies to disaggregants, as well as ASA, blood thinning. Naturally, the higher power and strength of the Plavix action will never push the ASC to the second and third positions. The fact is that aspirin is immeasurably cheaper, and also widespread and safe to use. Clopidogrel, on the other hand, has a completely different mechanism of action associated with the irreversible change of specific receptors on platelets.
For the first time, clopidogrel was introduced into clinical practice in 1997, and was initially used in fairly serious cardiac patients. Indications for prescription were acute coronary syndrome, including those with ECG changes, percutaneous coronary intervention, and other cases. Sufficiently high efficacy was noted in patients with unstable angina.In an outpatient clinic, it is important that a lot of experience has been gained with the use of clopidogrel in patients with atherosclerosis, in particular with chronic cerebral ischemia. Therefore, if a patient has resistance to antithrombotic therapy, and aspirin alone does not cope with improving the rheological properties of blood, then clopidogrel is the drug of choice or expansion of the scheme, especially if the cardiovascular system is already compromised by myocardial infarction. or the presence of unstable angina.
One of the important advantages of clopidogrel over acetylsalicylic acid is the ability to prescribe it to patients with unstable angina, which is based on vasospasm, and aspirin is contraindicated in this diagnosis.
It is important that Plavix can be used not only as monotherapy, but also with acetylsalicylic acid, and even as part of a triple antithrombotic therapy. Thus, Plavix was effective in such a complex combination as its combined use with acetylsalicylic acid and the anticoagulant Warfarin. This combination may be necessary in patients with atrial fibrillation and prosthetic heart valves.
Typically, the standard dosage of Plavix in patients with atherosclerotic vascular changes who have recently had a heart attack or stroke is 75 mg per day. Already at this dosage, a statistically significant reduction in the risk of recurrent heart attack, stroke and cardiovascular death occurs. It is important that the use of clopidogrel was associated with a significantly lower number of side effects such as the development of gastrointestinal bleeding, compared with acetylsalicylic acid. Plavix should be taken for a long time.
Currently, the pharmacy can be purchased as original liquefaction drugs - Plavix manufactured by Sanofi and generics. So, Plavix's packaging with a dosage of 75 mg, calculated on a monthly course, costs 990 rubles on average. Indian generics, for example, such as Clapitax, will cost half the price. Klopidogrel Canon, produced by the domestic pharmaceutical company ZAO Kanonpharma Production, will cost 340 rubles. Perhaps this is one of the cheapest analogues in the domestic market.
Advantages and disadvantages
First of all, you need to remember that Plavix, or any clopidogrel, is a serious remedy for compromised patients. You should not take it just relatively young people with low levels of physical activity, overweight and bad habits. In this case acetylsalicylic acid will do well with prophylaxis. But patients with the development of systemic atherothrombosis, after various heart surgeries who have had a heart attack or stroke, need this medication for secondary prevention.
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 cardiac death, when compared with a separate intake of ASA. Clopidogrel's minus is considered to be a fairly high cost, and the need for its use is regularly monitored for various bleeding options, as well as monitoring the functional state of the liver.
Trental, Agapurin, Vazonit (pentoxifylline)
Rating: 4.6
Previous drugs, such as acetylsalicylic acid and clopidogrel, regulated blood clotting by changing the properties of platelets. Trental (pentoxifylline by INN) has a thinning effect in several ways. It reduces platelet aggregation, but also affects red blood cells. It improves their ability to tolerate deformation, especially penetrating through small capillaries.Pentoxifylline reduces the concentration of fibrinogen, which regulates the rate of blood clots, reduces the ability of white blood cells to adhere, or adhesion, to the inner vascular wall. Therefore, as a result, the normalization of the rheological properties of blood is complemented by improved microcirculation and a vasodilator or vasodilating effect.
Pentoxifylline is the active substance, and the mechanism of action of this compound is associated with a decrease in the activity of phosphodiesterase (PDE) in the muscle cells of blood vessels and in blood elements.
The great value of this drug is the improvement of capillary blood flow, or microcirculation, in areas with their violation. Therefore, pentoxifylline and its varieties are indicated for all vascular diseases that are accompanied by capillary blood flow disorders.
These are various trophic ulcers on the legs, including diabetes and the severe stages of varicose disease. Pentoxifylline is prescribed for diabetic angiopathy, for various disorders of cerebral circulation. Most often, Trental is prescribed to patients with cerebral atherosclerosis, but can also be used in patients with post-traumatic and alcoholic encephalopathy, with dizziness, with memory impairment. Trental is indicated in the case of the development of sensorineural hearing loss, with circulatory disorders in the retina. He is appointed in outpatient practice in tablets of 100 mg, three times a day, followed by a gradual increase in dose by half. In this case, pentoxifylline can not be used more than 1200 mg 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 vasodilating effect, and can independently lower blood pressure. The duration of the course is set by the doctor.
Trental is produced by the manufacturer Sanofi-Aventis, and the average cost per 60 tablets of 100 mg is 530 rubles. With an average dosage of 600 mg per day, this package is enough for only 10 days, and the monthly cost of the course will be about 1600 rubles. Therefore, Trental cannot be considered a cheap remedy.
Advantages and disadvantages
A great advantage of Trental will be the ability to influence the microvasculature. This allows him to cope with fairly complex conditions in which there are various trophic disorders. However, it is contraindicated for massive bleeding, various acute processes, such as heart attack and stroke, retinal hemorrhage. Do not use it in pregnant women, in nursing mothers and in children. There are many relative contraindications. One of them is the joint appointment of Trental with clopidogrel and acetylsalicylic acid. Unlike its predecessors, this tool does not apply with other medicines of the kind of antiplatelet agents. But, despite all the drawbacks, pentoxifylline is indispensable for large groups of patients who suffer from chronic peripheral blood circulation disorder in the elderly, whether it be lower limbs, retina or microvasculature of the brain.
Wessel Due F, Angioflux (sulodexide)
Rating: 4.5
Perhaps the latest in the cohort of “big” drugs for blood thinning can be called Vessel Due F. Its active ingredient is sulodexide, and there are almost no analogues on the domestic pharmaceutical market. You can still find Angioflux, which produces the domestic company Sotex Pharma. The original Wessel Due F is produced by the Italian pharmaceutical company Alfa Wasserman. This blood thinning drug is available in ampoules, in capsules of 250 units each, and a package of sulodexide in 50 capsules will cost from 2,700 rubles.
As can be seen, sulodexide is very expensive for the average Russian drug consumer.Why is he so expensive? Sulodexide improves the rheological properties of blood, reduces blood clot formation, protects blood vessels, and incidentally has an anticoagulant effect. That is, it acts not only on the cellular, platelet link, but also on plasma factors of hemostasis. Sulodexide is a naturally occurring natural compound of animal origin. It stands out from the mucous membrane of the pig intestines. The main component is the low molecular weight heparin-like fraction. Thus, the drug does not affect platelets, not their tendency to thrombosis, but shows a special affinity for certain coagulation factors: antithrombin III and the heparin II cofactor.
Therefore, the antithrombotic effect is realized in completely different ways than that of acetylsalicylic acid, clopidogrel and pentoxifylline. Activation of the X plasma coagulation factor is suppressed, prostacyclin secretion increases, and the amount of fibrinogen decreases. Therefore, Wessel Due F is expensive: it acts gently, but at once on several links of hemostasis, both cellular and plasma. It is a disaggregant and anticoagulant “in one bottle”.
Sulodexide is indicated for use in patients with a high risk of thrombosis: after a heart attack, in various forms of hypertensive encephalopathy complicated by atherosclerosis. Wessel Due F is shown in the treatment of patients with diabetes, hypertension and vascular dementia. This remedy is successfully used in patients with occlusive lesions of the arterial vessels of the lower extremities on the background of atherosclerosis and diabetes. A very important indication is the treatment of a particular complication called heparin-induced thrombocytopenia. It develops sometimes after taking heparin.
Initially, the drug is usually applied intramuscularly for 2-3 weeks, and then by mouth, one capsule per day between meals for a month.
Advantages and disadvantages
The advantage of Vessel Due F can be considered its effectiveness and good tolerance. Overdose are rare, side effects are mild. Most often, various functional disorders of the gastrointestinal organs and allergic reactions can occur. This drug under the supervision of a physician can be used in pregnant women and nursing mothers, except for 1 trimester of pregnancy. A strict contraindication can be considered hypersensitivity and increased bleeding, or the manifestation of hemorrhagic diathesis. Perhaps such a mild action and a small number of contraindications are dictated by the natural origin of sulodexide. At the moment, Wessel Due F is an indispensable tool for the complex therapy of various thrombotic conditions, disorders of the peripheral 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 means for improving the rheological properties of blood did not include drugs derived from leeches, drugs for the treatment of varicose disease based on hesperidin, diosmin and escin, many medicinal products based on medicinal plants and traditional blood thinners. . This rating included only those drugs that have proven global efficacy and a large clinical base of research, and at the same time have a systemic effect.
Attention! This rating is subjective, is not advertising and does not serve as a guide to the purchase. Before buying, you should consult with a specialist.
