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Other names: Sorbitrate

MEDICATIONS OFTEN PRESCRIBED FOR PATIENTS WITH HEART DISEASE: DRUGS THAT ACT ON THE CLOTTING MECHANISM (“BLOOD THINNERS”)
As mentioned above, the “final straw” in a heart attack is the formation of a clot inside the blood vessel. The blood-clotting mechanism is activated by injury inside the blood vessel wall, much as blood will clot when you cut yourself because of injury to the skin and the blood vessels underneath it. Clotting is caused by the activation of blood elements called platelets, which stick together to plug holes in the blood vessel wall, and then by the formation of a blood clot itself, which is a complex lattice of proteins that otherwise circulate in the blood. In the case where the damage is inside the blood vessel itself, these clots can block up the inside of the blood vessel (known as the lumen), and are highly undesirable. One can counteract these processes by interfering with the action of the blood platelets, preventing them from sticking together; preventing blood from clotting by interfering with the proteins that lead to the clot itself; or dissolving the clots after they have been formed.
Heparin is an agent given intravenously that prevents clots themselves from forming, and has been long used and is very effective in “acute coronary syndromes,” such as unstable angina or heart attack. The drug is used with most patients who arrive at the hospital with prolonged chest pain, and newer types of heparin may also be used on an outpatient basis, injected under the skin. Heparin is very effective in preventing heart attacks and some of their complications! but is used only for the short term and usually in the hospital. The dose needs to be carefully regulated by means of frequent blood tests, and it is common to have bruising when heparin is administered. Although this is unsightly, it is usually not dangerous or painful.
Warfarin (perhaps better known by its brand name, Coumadin?) is a blood thinner taken daily by mouth and is extremely useful in treating many cardiac disorders. It is especially helpful in preventing strokes in predisposed patients, most particularly those with atrialfibrillation. It is also used to prevent clotting in patients with artificial heart valves and for some patients with a prior heart attack, especially if there is marked enlargement of the heart or evidence for clot formation in the heart. Patients on warfarin require regular blood tests, usually weekly or every two weeks, to regulate the “thinness” of the blood. This test is extremely important since the effect of the drug can vary over time with changes in diet, activity, or even the seasons. For example, green leafy vegetables and other foods that contain vitamin K tend to counteract the effect of warfarin and, as the diet changes, so can the drug’s effects. The blood tests very accurately indicate the effectiveness of the drug, and the result is expressed as the international normalized ratio (INR), which can be thought of as the time taken for the blood of patients on this drug to clot with respect to normal blood. The value in patients on no drugs is i, and the desired value for most patients on warfarin is between 2 and 3. Values less than 2 therefore indicate blood that is clotting too rapidly (“insufficiently thin”), and values above 3 for most patients indicate excessive thinness of the blood (exceptions include patients with plastic and metal heart valves, and some others). Your doctor will tell you what INR value is ideal for you. It needs to be stressed that patients should not take warfarin without close medical supervision. Many medications can interfere with the action of warfarin, and thus your doctor and your pharmacist should be made aware of all medications you are taking.
Thrombolytics, or “clot busters,” have been in use for about ten years to minimize the amount of heart damage after a heart attack. The original clot buster was called streptokinase, and most patients now get a more effective form called tPA. This drug acts to dissolve a clot that has already formed, allowing blood flow in a completely blocked artery to be at least partially restored. These drugs are very effective, especially when given early after the onset of a heart attack, restoring blood flow in over 75 percent of cases. However, to be most effective, they need to be administered as early as possible after the onset of a heart attack, preferably within the first few hours. Clot busters are generally quite safe, although they may cause bleeding in less than 1 percent of patients. The effectiveness of these drugs is the main reason why it is so important to go to the hospital if you have had chest pain, tightness or discomfort that has lasted more than thirty minutes, especially if it has not gotten better with nitroglycerin (by spray or tablets under the tongue).
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