How Medication Therapy Management (MTM) Can Benefit Patients on Anticoagulants

Ask your pharmacist during a medication therapy management (MTM) review about your "blood thinner" (anticoagulant). New medications called direct oral thrombin inhibitors and selective Factor Xa inhibitors are becoming increasingly prescribed as the preferred anticoagulant for patients replacing warfarin which is commonly sold as Jantoven® or Coumadin®. These newer agents do not need monthly lab work for proper dose monitoring and have less food and drug interactions associated with them than warfarin, therefore rendering them a little more "patient friendly." However, these new agents have precise xeralto  dosing requirements for different medical indications that are necessary for their safe and effective use.
Medications that "thin" our blood are extremely important in health care as they prevent and treat blood clots (embolism) that can cause illness and death (severe morbidity and mortality).

Warfarin is commonly called "rat poison" because it was first sold after its discovery as a rodenticide. In a Wisconsin lab, due to a farmer's determination to find out why his cows were bleeding to death, scientists discovered that when hay became wet and moldy, the natural compound, coumarin, found in "sweet" clover became oxidized and changed to the active anticoagulant compound, dicoumarol. As you might surmise, normally farmers wouldn't feed their farm animals moldy hay, but the Great Depression had left them with little money and no choice but to use all feeds. When the farm animals ate the moldy hay that contained the active dicoumarol, their blood "thinned", causing many animals to die from internal bleeding, then coined "sweet clover disease." ¹

These new anticoagulants also have an interesting history of discovery. Hirudin, which is a potent thrombin inhibitor, is secreted by salivary glands of medicinal leeches, (still used today), Hirudo medicinals. Thrombin activates proteins to form blood clots.Hirudin is a potent inhibitor of thrombin, and noted during a 1985 study: "purification of large quantities of hirudin from leeches for further clinical testing or eventual clinical use was highly impractical, but this problem could be potentially solved by recombinant DNA technology".²

Decades of scientific research plus refinement of DNA technology brought clinically usable new anticoagulant medications to the market in 2008. Xarelto® (rivaroxaban -oral selective Factor Xa inhibitor) and Pradaxa® (dabigatran - oral direct thrombin inhibitor) are introduced as alternatives to warfarin for some medical indications requiring anticoagulation or blood thinning.

Ask your pharmacist during your next MTM review about these new agents if you take a blood thinner. Question them about the proper dosage, cost difference and risk of bleeding. Monitoring signs of "too thin" blood are; unexplained bruising, nose bleeds that are difficult to stop, or blood in the toilet. Seek medical advice soon (that day) when you have concerns about your medication and signs of bleeding. Make this a part of your medication action plan (MAP) with your MTM pharmacist, if you are taking an anticoagulant. Just as it is important to prevent and treat blood clots by thinning blood with anticoagulants, it is also equally important to stop unwanted bleeding.

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