* Review of the best according to the editors of ecdfburma.org. About the selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.
This review will focus on medicines called “blood thinners” in the home. In RuNet, there are numerous materials on this topic in which you can find information about a variety of tools. Such articles describe a variety of drugs that are not only designed to improve fluidity, that is, blood rheology, but are also folk remedies. Information is provided on substances obtained from living structures (hirudin), on thinning drugs for the treatment of varicose veins based on plant components. Such a "free room" of all these numerous, various means, biological preparations and plant extracts in the group "blood thinners" is not entirely correct.
In fact, there is a rather limited number of drugs that have proven effectiveness and systemic effects, which belong to the category of so-called disaggregants, or that improve the rheological properties of blood (improve its fluidity).
A little about the density of blood and its rheological properties
But before proceeding with the description of disaggregants - these prophylactically important medicines that thin the blood and save hundreds of thousands of lives, you need to understand what a "deterioration in blood flow" is and how such blood differs from "thick blood".
There is such a simple laboratory indicator as hematocrit. Hematocrit is called the percentage, volumetric ratio between the liquid part of the blood, or its plasma, and cells - shaped elements. Than this ratio is greater than the blood thicker. This density can occur due to an absolute factor, for example, excessive reproduction of all blood cells with a normal amount of plasma (true polycythemia, or Wakez’s disease).
But much more often, the hematocrit increases due to a decrease in the amount of 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. There is also physiological dehydration. For example, prolonged hard physical labor in a dry, hot climate and intense sweating.
Does blood thicken during these processes? Of course, it is thickening. Are blood thinners needed in this case? 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 are called drugs that dilute it? These are funds from two groups: anticoagulants and antiplatelet agents.
- Anticoagulants, or drugs that inhibit blood coagulation processes are prescribed only by a doctor, and are not sold in pharmacies without a prescription. These include some tablet preparations, for example, Warfarin, Phenylin. But much more often used such funds that are administered subcutaneously. This is heparin and its modifications, which are related to more modern low molecular weight fractions, for example, Fraxiparin. Since these drugs can cause a significant amount of side effects during self-medication, these drugs will not be considered in this review.
- Drugs from the group of disaggregants (thinning) reduce the adhesion of blood cells to each other (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. As you know, thrombosis underlies 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, certain forms of hypertension with a high risk of heart attack and stroke, atherosclerosis and an increased concentration of cholesterol in blood plasma. A separate indication for the appointment of disaggregants is the overall increased risk of heart attack and stroke in the population. So, the male population of large cities of Russia in overwhelming numbers after 45 years of age has such a risk, so if a man older than 45 years has a tendency to sedentary work, overweight, he has bad habits and especially smoking, then he is shown a reception disaggregants.
In world practice, not so many drugs from this group are known that have proven effectiveness, but each of them has been tested for many years by tens of thousands of volunteers and patients with a wide variety of pathologies. It was they who entered the rating. It is opened by such a well-known drug as acetylsalicylic acid, colloquially called by one of the oldest trade 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 ₽|
|2||Curantyl (dipyridamole)||525 ₽|
|3||Plavix, Deplatt, Zilt, Clopigrant, Lopirel, Egithromb (clopidogrel)||947 ₽|
|4||Trental, Agapurin, Wasonite (pentoxifylline)||144 ₽|
|5||Wessel Douai F, Angioflux (sulodexide)||2 351 ₽|
Acetylsalicylic acid (Cardiomagnyl, Thrombo-Ass, ASA - Cardio, Aspirin-Cardio)
Acetylsalicylic acid is the progenitor of a large and very 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, which have the most powerful ability to suppress inflammation.
Acetylsalicylic acid is an artificially enhanced natural variety of one of the salicylates, which was previously used in medicine as an antipyretic. Most of it was contained in the bark of white willow (salicin), there is it in raspberries. The artificial molecule of acetylsalicylic acid is a much stronger substance.
During the 20th century, many different products from this group were created, such as Ibuprofen, Meloxicam, Nimesulide and others. All of them, to varying degrees, are able to suppress the development of inflammation, reduce pain, and have an antipyretic 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 prolonged use significantly reduces 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 the blocking of the enzyme cyclooxygenase type 1 (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 the aggregation or adhesion of platelets to each other, and suppression of the induction of thrombosis. The establishment of this fact was a real gift for medicine. A great deal of practical material has been accumulated over decades, and at present the minimum dosage, which with daily intake is able to reduce the risk of developing vascular accidents, is 75 mg. The standard dosage ranges around 100 mg in terms of acetylsalicylic acid.
All cardiac "aspirins" are designed for long-term use, and are used before meals with plenty of fluids. The main indications, as mentioned above, are the prevention of acute myocardial infarction, the secondary prevention of heart attacks and ischemic strokes. Cardiac "aspirin" is used to prevent thromboembolic complications after surgery and various vascular interventions. Indications for the use of ASA (acetylsalicylic acid) are very wide. These are diabetes and obesity, angina pectoris and the risk of developing 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 grafts, including after valve operations and after coronary artery bypass grafting.
Nevertheless, acetylsalicylic acid, even in such small doses, but used for a long time, has its contraindications. First of all, this is an exacerbation of peptic ulcer of the stomach and duodenum, as well as erosive gastritis. These are conditions with a high risk of gastrointestinal bleeding, low blood coagulation, hemorrhagic diathesis. In no case should you use it during pregnancy, during lactation and to persons under the age of 18 years. The use of acetylsalicylic acid is strictly forbidden to children due to the possible development of Reye's syndrome up to a fatal outcome, therefore, either ibuprofen or paracetamol preparations are prescribed for children to reduce fever and reduce 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 insufficiency. There are also a large number of relative contraindications, for example, such as gout, hyperuricemia, the condition before surgery due to the possible development of bleeding.
Overdose symptoms may also occur, and they are especially dangerous in the elderly, therefore, prescribe ASA for prolonged use should only be a doctor.
Currently, in pharmacies you can buy a large number of varieties of acetylsalicylic acid in a low dosage, the so-called "cardiac aspirins." So, if we consider the 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;
- Aspicor of the domestic producer ZAO Verteks 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 drugs is about the same. If we consider an imported drug, for example, Thrombo - ACC in the same dosage and in the amount of 28 tablets produced by the Austrian company Lannacher, then its cost will be the same - 52 rubles. for packing.
About enteric forms and systemic action
Currently, the so-called “enteric-soluble forms” of acetylsalicylic acid, or blood-thinning tablets that bypass the stomach and dissolve only in the small intestine, are very popular on the pharmaceutical market. This fact is achieved by adding a special coating for the tablet of acetylsalicylic acid, which consists of magnesium hydroxide. Everyone knows that this base is part of antacid preparations, and simply helps acetylsalicylic acid to bypass the acidic environment of the stomach.
According to manufacturers, this device helps to 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 the gastric mucosa.
But in fact, quite a long time ago it was proved that the action of acetylsalicylic acid, which is ulcerogenic or that promotes the activation of a stomach ulcer, is a systemic effect. This means that ASA harms the stomach not only locally, being inside it, but already having completely passed the entire gastrointestinal tract, and sucked into the blood. This means that betting only on local cover when taking acetylsalicylic acid will be an insufficient way to protect against systemic side effects, and this can be regarded as an element of an advertising strategy.
Perhaps the most famous drug in this group will be Cardiomagnyl. You can also name such tools as Thrombital, Thrombomag, Phasostabil and so on. The price of these tablets is slightly higher than just tablets without a protective, acid-resistant coating. So, a pack of Cardiomagnyl in 30 tablets of 75 mg per month is, on average, 135 rubles.
Pros and Cons of ASK
Whatever the disadvantages of acetylsalicylic acid, anyway, the benefit significantly outweighs all kinds of shortcomings (of course, if the appointment and administration of the drug is under medical supervision). The main disadvantages will be absolute contraindications - exacerbated gastric ulcer, the risk of gastrointestinal bleeding, childhood and all those conditions that were mentioned above. Bleeding may develop if tooth extraction and other manipulations are performed while taking aspirin. There is a fact of the development of aspirin asthma, individual intolerance to this agent and other conditions.
But still, taking into account 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 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 life-prolonging agents in the presence of cardiovascular risk factors.
Dipyridamole, or Curantyl, is the second drug from the group of disaggregants to thin the blood with proven effectiveness, but it is prescribed less frequently than acetylsalicylic acid. And this is not justified: the advertising of ASA is so strong that it “pushed into the shadow” dipyridamole. Curantyl not only improves the rheological properties of blood and helps to reduce platelet aggregation, but also has other systemic hemodynamic effects. So, it dilates blood vessels, and this effect is especially noticeable on small coronary arteries and arterioles.
As a result, Curantil reduces total peripheral vascular resistance, helps to lower blood pressure, and further contributes to the normalization of venous outflow. In the brain, it reduces the resistance of cerebral vessels, and in obstetrics and gynecology it is able to 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 immunomodulating effects.
Curantyl is prescribed in the same way as acetylsalicylic acid, in order to prevent arterial and venous thrombosis, thromboembolism, and in case of microcirculation disorders. A special indication will be the prevention of pulmonary embolism after surgery, after valve surgery. Curantyl is indicated as a means to stop 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 in several doses.The tool as a vasodilator and for prevention is used for a long time, under the supervision of a doctor.
A separate indication, and very unusual for thinners, will be the prevention of influenza and respiratory viral infections. For this, drugs are used in a minimum dosage of 25 mg 2 times a day (on one day). This dosage is applied only once a week, for a month. That is, a month a person consumes Curantil for only 4 days.
The Curantil is produced by the famous German pharmaceutical company Berlin-Chemie, the Menarini group. A package of 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 be enough for about a month and a half. If you need twice as high dosage, then this package may last only one month or even less. There are domestic analogues, for example dipyridamole, which is produced by the pharmaceutical company Obolenskoye. So, 120 tablets can be purchased at a price of only 387 rubles. This is of course a much smaller amount.
Pros and cons
The advantage of dipyridamole, or Curantyl, will be the ability to use it as a vasodilator (vasodilator), which is deprived of acetylsalicylic acid. It should be prescribed to patients several times a day, a flexible approach with respect to the daily dose, which can range from 75 to 600 mg, is important. The possibility of its use in obstetrics and gynecology is important, including not only for preventive, but for therapeutic purposes.
Few specialists prescribe dipyridamole as an antiviral or immunomodulatory substance, but, nevertheless, some experience has been gained in its use during periods of an acute respiratory viral infection and influenza. Of course, dipyridamole is considered a more expensive drug than the numerous trade names for acetylsalicylic acid, but it also "works" not only as a 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, severe forms of hypertension and hypotension, hemorrhagic disorders, and childhood. It is especially necessary to remember that coffee and tea, which are consumed in significant quantities, weaken the effect of exposure to Curantyl.
Plavix, Deplatt, Zilt, Clopigrant, Lopirel, Egithromb (clopidogrel)
Plavix, or clopidogrel (INN), will be a serious medicine, and also refers to disaggregants, as well as an ASA that dilutes blood. Naturally, the higher power and force of action of Plavix will never push ASK into second and third positions. The fact is that aspirin is immeasurably cheaper, as well as widespread and safe to use. Clopidogrel has a completely different mechanism of action associated with an irreversible change in specific receptors on platelets.
Clopidogrel was first introduced into clinical practice in 1997, and was initially used in fairly serious cardiac patients. Indications for use were acute coronary syndrome, including changes in the ECG, percutaneous coronary intervention, and other cases. A sufficiently high efficiency was observed in patients with unstable angina pectoris. In an outpatient clinic, it is important that extensive experience with the use of clopidogrel in patients with atherosclerosis, in particular with chronic cerebral ischemia, has been accumulated. Therefore, if the patient has resistance to antithrombotic therapy, and aspirin alone does not cope with the improvement of the rheological properties of blood, then clopidogrel is the medicine of choice or expansion of the regimen, 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 will be 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 triple antithrombotic therapy. So, 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 with 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 decrease 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. It is necessary to take Plavix for a long time.
Currently, in the pharmacy you can buy both original liquefaction medicines - Plavix manufactured by Sanofi, and generics. So, a Plavix package with a dosage of 75 mg, designed for a monthly course, costs an average of 990 rubles. Indian generics, such as Klapitaks, will cost half as much. Clopidogrel Canon, manufactured by the domestic pharmaceutical company Canonfarm Production CJSC, will cost 340 rubles. Perhaps this is one of the cheapest analogues in the 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 for relatively young people with a low level of physical activity, excess weight and bad habits. In this case, acetylsalicylic acid can fully cope with prophylaxis. But for patients with the development of systemic atherothrombosis, after various heart operations after a heart attack or stroke, it is necessary to use this medicine for secondary prevention.
A very big plus will be the fact that it is combined with acetylsalicylic acid, and to such individuals it significantly reduces the risk of cardiac death when compared with a separate intake of ASA. The minus of clopidogrel is considered to be a fairly high cost, and the need for regular use against the background of its use, to monitor various bleeding options, as well as to monitor the functional state of the liver.
Trental, Agapurin, Wasonite (pentoxifylline)
Previous drugs, such as acetylsalicylic acid and clopidogrel, regulated blood coagulation by modifying platelet properties. Trental (pentoxifylline according to INN) has a diluting 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 adhesion, or adhesion, of white blood cells to the inner vascular wall. Therefore, as a result, the normalization of the rheological properties of blood is supplemented by an improvement in microcirculation and a vasodilating or vasodilating effect.
Pentoxifylline is an active substance, and the mechanism of action of this compound is associated with a decrease in the activity of phosphodiesterase (PDE) in vascular muscle cells and in blood elements.
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 impaired 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, 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, and memory impairment. Trental is indicated in the case of the development of sensorineural hearing loss, with circulatory disorders in the retina. It is prescribed in outpatient practice in tablets of 100 mg three times a day, followed by a gradual increase in the dose by half. In this case, pentoxifylline cannot be used more than 1200 mg per day in three divided 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 packaging cost of 60 tablets of 100 mg is 530 rubles. With an average dosage of 600 mg per day, such a package will last only 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 act on the microvasculature. This allows him to cope with rather complex conditions in which various trophic disorders occur. However, it is contraindicated in case of 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 co-administration of Trental with clopidogrel, and acetylsalicylic acid. Unlike its predecessors, this tool is not used with other drugs from the genus of disaggregants. But, despite all the disadvantages, pentoxifylline is indispensable in large groups of patients who, in old age, suffer from a chronic peripheral circulation disorder, whether it be the lower extremities, the retina or the microvasculature of the brain.
Wessel Douai F, Angioflux (sulodexide)
Perhaps the last in a cohort of "large" blood thinners is Wessel Douay F. Its active ingredient is sulodexide, and there are almost no analogues on the domestic pharmaceutical market. You can also find Angioflux, which is produced by the domestic company Sotex Pharma. The original Wessel Douai F is produced by the Italian pharmaceutical company Alfa Wasserman. This medicine for blood thinning is available in ampoules, in capsules of 250 units each, and a package of sulodexide in 50 capsules will cost from 2700 rubles.
As you can see, sulodexide is very expensive for the average Russian drug consumer. Why is he so dear? Sulodexide improves the rheological properties of blood, reduces thrombus formation, protects blood vessels and simultaneously has an anticoagulant effect. That is, it acts not only on the cellular, platelet link, but also on the plasma factors of hemostasis. Sulodexide is a naturally occurring compound of animal origin. It is secreted from the mucous membrane of the porcine intestine. The main component is the low molecular weight heparin fraction. Thus, the drug does not affect platelets, nor their tendency to thrombosis, but exhibits a special affinity for certain coagulation factors: antithrombin III and the cofactor heparin II.
Therefore, the antithrombotic effect is realized in completely different ways than in acetylsalicylic acid, clopidogrel and pentoxifylline. The activation of the X coagulation factor of plasma is suppressed, the secretion of prostacyclin is enhanced, and the amount of fibrinogen is reduced. Therefore, Wessel Douai 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, with various forms of hypertensive encephalopathy complicated by atherosclerosis. Wessel Douay F is indicated in complex therapy for patients with diabetes mellitus, hypertension and vascular dementia. This agent has been successfully used in patients with occlusive lesions of the arterial vessels of the lower extremities against the background of atherosclerosis and diabetes. A very important indication is the treatment of a particular complication called heparin-induced thrombocytopenia. It sometimes develops after taking heparin.
Initially, the drug is usually used intramuscularly for 2-3 weeks, and then inside, one capsule per day between meals for a month.
Pros and cons
A plus of Wessel Duet F can be considered its effectiveness and good tolerance. Overdoses are rare, side effects are mild. Most often, various functional disorders from the organs of the gastrointestinal tract, and allergic reactions can occur. This drug under the supervision of a doctor can be used in pregnant women and in nursing mothers, except for 1 trimester of pregnancy. Hypersensitivity and increased bleeding, or the manifestation of hemorrhagic diathesis, can be considered a strict contraindication. Perhaps such a mild action and a small number of contraindications are dictated by the natural origin of sulodexide. Currently, Wessel Douay F is an indispensable tool for the complex treatment of various thrombotic conditions, peripheral circulatory disorders, 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 improving the rheological properties of blood did not include drugs obtained from leeches, agents for the treatment of varicose veins based on hesperidin, diosmin and escin, many drugs based on medicinal plants and folk remedies for blood thinning . This rating includes only those drugs that have proven worldwide effectiveness and a large clinical base of research, and at the same time have a systemic effect.
Attention! This rating is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.