Blood flows unceasingly through our body. In adults, there are five to six liters, which carry nutrients and oxygen to the last cell of the body, to name only one of the many tasks of the blood. Just as vital to the organism is that the blood stops flowing at the crucial moment. Otherwise, any minor injury would cause a dangerous bleeding. Hemostasis is the process by which bleeding is stopped.
Hemostasis: The normal course
Hemostasis is divided into two phases: primary and secondary hemostasis. Primary hemostasis is the immediate reaction of the body to injury. Platelets, a regular component of the blood, attach to the edges of the wound and form a plug-like seal. At the same time, the blood vessel contracts, the blood circulation is throttled and thus less blood comes out.
The time from the first drop of blood to the first closure of the injured area usually takes two to three minutes and is referred to as bleeding time. The occlusion by the platelets is not yet stable. A permanent, firm closure occurs via the secondary haemostasis, and this is called the activation of blood clotting. This is a variety of coagulation factors involved.
Like a series of dominoes, where one stone abuts the next, a coagulation factor activates the next, until finally a whole cascade has expired and the defect is reliably closed with a stable clot until final repair.
Increased clot tendency
Many people are more likely to clot. The causes for this are manifold, such as an altered composition of the blood or a change in the flow rate. But changes in the vascular wall play a special role
- as a result of an injury,
- as a result of inflammation,
- or in the context of atherosclerosis.
The changes fatally activate hemostasis and clot formation in the blood vessel. This can lead to the complete occlusion of the affected blood vessel, or to carry over the clot with the bloodstream in a far-away blood vessel, such as in the brain or in the lungs with serious consequences for the organism.
Medicines for blood clots
To prevent this, various drugs are used in the tendency to clots. Once the antiplatelet agents (TAH), which are drugs that prevent the clumping of platelets, in the jargon platinum, to a clot. Furthermore, the anticoagulants, these are substances that interrupt the coagulation cascade.
The best-known drug from this group is acetylsalicylic acid, short ASS. It prevents the formation of clots in the arteries in atherosclerosis and is usually long-term after a heart attack or stroke. However, ASA prevents clots in the veins, which is why it is not suitable, for example, for the prevention of a so-called "economy-class syndrome", ie a venous thrombosis, for example in long-haul flights.
ASA can cause gastritis, and even gastric ulcer and gastric bleeding, so patients should consult their doctor for complaints such as acid reflux or diffuse nausea in the stomach. People with asthma may be allergic to ASA, and caution should be exercised when taking it. The drug may not take, who had a stomach ulcer, and also prohibited it is in the last third of the pregnancy.
Caution is advised, if additional pain medications are needed, these can weaken the effects of ASA. On the other hand, when taken with anticoagulants, ASA can lead to severe bleeding. And if you get ASA, you should notify the attending physician that you have planned a surgical procedure because there is an increased risk of bleeding when taking ASA. If it is safe, ASA should be discontinued one week before the procedure. Because it takes so long, until the effect has subsided. Other substances of this group have been used mainly as a reserve, so only if a patient does not tolerate ASA.
Anticoagulants against blood clots
Of the drugs that interrupt the coagulation cascade, coumarins are relevant outside the hospital. They reduce the risk of clot formation throughout the bloodstream, both in the arteries and in the veins. They are used for example in patients after a leg vein thrombosis, after a pulmonary embolism or a heart attack. An adverse reaction may be an intolerance, but also hair loss or liver inflammation. Therefore, for example, liver patients may not get coumarins.
Who takes Cumarine, must be continuously cared for. Because the coagulation is reduced too much, it can lead to dangerous bleeding. On the other hand, if it is not lowered enough, the effect may not be sufficient and a clot may form. Therefore, the so-called therapeutic area is regularly controlled by a blood sample and then set the daily tablet intake. Patients who need to take the medicine over the long term can learn in a training session to determine their coagulation value and then independently adjust their tablet intake.
In everyday life, coumarin patients need to be aware that they bleed longer in injury than other people. However, blood clotting is not completely eliminated, and for small wounds it is usually sufficient to press on the wound for a few minutes with a clean gauze compress or other suitable dressing material. For larger wounds, however, a doctor should be consulted who may be administering a drug that quickly raises coagulation. Caution is also advised when bleeding occurs for no apparent reason, such as nosebleed or blood in the stool.
Coumarins and nutrition
Incidentally, vitamin K cancels the coagulation of coumarin. However, the effect is slow, so taking drugs with vitamin K as an antidote for an emergency does not make sense. However, vitamin K is also important because many foods contain vitamin K in large quantities, such as spinach and broccoli.
Nevertheless, a coumarin patient does not have to do without these foods, they should only be eaten evenly throughout the week and not in large quantities. There are no other food restrictions, there is no "coumarin diet".
Caution should be exercised with coumarin patients
When visiting a doctor, it should always be pointed out that coumarins are taken. Because a syringe in the muscle is not allowed in coumarin patients, and even the pulling of a tooth wants to be well planned. Also, there are a variety of drugs that increase or decrease the effects of coumarins, which is why taking other medicines should only be done after consultation with the doctor.
Very important: Who takes Cumarine, receives a card, in which, among other things, the coagulation values and the tablet intake are noted. You should always carry this badge with you!
Knowledge means safety
People who take anti-clotting drugs often need them for a lifetime. This statement should not discourage, but rather give the incentive to want to know as much as possible about the effects and side effects of "his" drug. Because the more you know about it, the safer you become when dealing with it. And once you have the whole thing under control, then a pretty "normal" life is actually nothing in the way.