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Anticoagulants are medications used to prevent the formation of thrombi, or blood clots, and they’re used to prevent or treat thromboembolic events, such as deep vein thrombosis, pulmonary embolism, ischemic stroke, transient ischemic attack, coronary artery disease or myocardial infarction.
They're also used in clients with coagulation disorders, including antiphospholipid syndrome and disseminated intravascular coagulation; as well as in clients who underwent coronary angioplasty or cardiac valve replacement; and during surgical procedures like cardiopulmonary bypass, percutaneous coronary intervention, extracorporeal membrane oxygenation, and in clients undergoing dialysis.
Now, anticoagulants work by interfering with the normal function of clotting factors involved in the coagulation cascade. One of the most important factors is factor X, which gets activated into Xa, and in turn activates factor II, also known as prothrombin, into factor IIa or thrombin. Thrombin further activates factors I, V, VIII, IX, and XIII. Factor I, also known as fibrinogen, is activated to form factor Ia, or fibrin, which binds to other fibrin proteins to form a crosslinked fibrin mesh.
Factor V gets activated and acts as a cofactor for factor X, while factor VIII acts as a cofactor for factor IX, and factor XIII helps fibrin form crosslinks. Ultimately, the fibrin mesh allows platelets to rapidly aggregate at the site of injury and form a platelet plug, which is a primary clot that can help stop the bleeding. So, based on the mechanism of action, some of the most important anticoagulants include direct thrombin inhibitors and factor Xa inhibitors.
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