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Brilinta vs Heparin
Introduction
For patients with heart conditions or those at risk of blood clotting, certain medications can help in preventing clots and managing symptoms. Brilinta and Heparin are two such drugs that are often prescribed for these issues. They each impact different aspects of the coagulation cascade to inhibit clot formation, but both have significant effects in patients needing anticoagulant therapy. Brilinta is an oral antiplatelet drug which prevents platelets from sticking together and forming a clot by blocking the P2Y12 receptor on their surface. Heparin, on the other hand, is usually administered via injection or intravenous drip and works by enhancing the activity of antithrombin III, an enzyme inhibitor that deactivates several enzymes involved in blood clotting.
Brilinta vs Heparin Side By Side
| Attribute | Brilinta | Heparin |
|---|---|---|
| Brand Name | Brilinta | Heparin |
| Contraindications | Should not be taken with certain types of medication without consulting a doctor, including antiplatelet agents, anticoagulants, and some NSAIDs. Unexpected withdrawal can increase the risk of heart attack or stroke. | Heparin therapy should always be closely monitored due to its potential risk of bleeding complications. It must not be used in patients with a known hypersensitivity to heparin or pork products, in those with uncontrolled active bleeding (except when due to disseminated intravascular coagulation), or in patients with heparin-induced thrombocytopenia. |
| Cost | Around $400 for 60 tablets of 90 mg | Around $50 for 10 vials of 1000 units/mL |
| Generic Name | Ticagrelor | Heparin |
| Most Serious Side Effect | Unusual or unexpected bleeding, signs of allergic reaction, chest pain, shortness of breath, rapid heartbeat, lightheadedness, signs of a stroke, severe headache followed by dizziness/fainting, presence of thrombocytopenia purpura syndrome symptoms. | Signs of an allergic reaction, unusual bleeding or bruising, blood in the urine or stools, blurred vision and headaches, confusion or changes in mental status, rapid heart rate. |
| Severe Drug Interactions | Drugs such as antiplatelet agents (like aspirin), anticoagulants (e.g., warfarin) and some nonsteroidal anti-inflammatory drugs (NSAIDs). | Interactions with other anticoagulants, platelet inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding. |
| Typical Dose | 180 mg as a loading dose, followed by 90 mg twice daily | Initial loading dose of 5000 units IV or subcutaneously, followed by maintenance doses typically between 10,000 to 20,000 units over 24 hours |
What is Brilinta?
Ticagrelor (the generic name for Brilinta) is an antiplatelet drug, representing a significant advancement over the older class of anticoagulants like Heparin. Ticagrelor was first approved by the FDA in 2011 and works by preventing platelets from clumping together to form harmful blood clots, effectively "trapping" them in a less activated state. It's primarily prescribed to prevent stroke, heart attack or other heart-related issues in people with certain types of cardiovascular disease. In contrast to Heparin which has broader effects on the coagulation cascade, Ticagrelor selectively inhibits adenosine diphosphate receptor on platelet cell membranes leading to less bleeding risks than traditional anticoagulants that have more extensive impacts on blood clotting proteins.
What conditions is Brilinta approved to treat?
Brilinta is approved for the treatment of different cardiovascular conditions:
- Acute Coronary Syndrome or a history of Myocardial Infarction (MI), also known as heart attack
- Prevention of stroke, in patients with acute ischemic stroke (NIH Stroke Scale score ≤5) or high-risk transient ischemic attack (TIA)
- As part of dual antiplatelet therapy, along with aspirin, for up to 60 months in patients with a history of MI and a high risk of developing an atherothrombotic event.
How does Brilinta help with these illnesses?
Brilinta (Ticagrelor) is an antiplatelet medication that works by preventing platelets in your blood from sticking together to form a clot. It achieves this through reversibly binding with the P2Y12 receptor on the platelets, blocking ADP from activating them and thus reducing their ability to clump together and cause blockages. This functionality makes Brilinta particularly effective at preventing heart attacks or strokes, especially in people who have already had one.
Heparin, on the other hand, is an anticoagulant that thins your blood to prevent it from clotting too easily. It does this by enhancing the activity of antithrombin III, a protein in your body that blocks certain enzymes involved in clot formation. However unlike Brilinta which primarily prevents new clots forming, Heparin can also help reduce existing ones.
Both drugs serve similar purposes but function differently and are used based on individual patient needs including pre-existing conditions and risk factors. As always when choosing between medications like these consult with healthcare professionals for advice tailored specifically for you.
What is Heparin?
Heparin, a blood-thinner or anticoagulant, has been in use since the 1930s and is widely recognized for its ability to prevent clot formation by inhibiting the action of thrombin. It does this by enhancing the body's own anti-clotting mechanism involving an enzyme called antithrombin III. This makes it particularly useful in situations where there is a high risk of blood clot occurrence such as deep vein thrombosis (DVT), pulmonary embolism (PE), and certain cardiac conditions.
It's important to note that Heparin doesn't break down existing clots but prevents them from getting bigger while your body naturally dissolves the clot over time. In contrast with drugs like Brilinta which work by preventing platelets from sticking together, heparin works directly on the coagulation cascade - a series of chemical reactions that lead to blood clotting.
Heparin can be administered intravenously or through subcutaneous injection under medical supervision due to its potential side effects including excessive bleeding and heparin-induced thrombocytopenia (HIT). Despite these concerns, when used appropriately under expert guidance, Heparin remains an effective tool in managing various cardiovascular conditions.
What conditions is Heparin approved to treat?
Heparin, a potent anticoagulant medication, has earned approval for several crucial medical applications including:
- Prevention and treatment of venous thrombosis (blood clots in the veins)
- Treatment of unstable angina and non-Q wave myocardial infarction
- Prevention of clotting in arterial and cardiac surgeries.
It is important to note that heparin works quickly to prevent blood from forming dangerous clots or emboli.
How does Heparin help with these illnesses?
Heparin, like Brilinta, is a potent medication used to prevent blood clots. Its primary role is in the prevention and treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and arterial thromboembolism. Heparin works by enhancing the activity of antithrombin III, an enzyme that deactivates several other proteins involved in blood clotting, thus preventing clot formation. This makes it extremely effective in conditions where there's a high risk of blood clots forming rapidly such as post-surgery or for those with certain heart conditions. The patient’s response to heparin can be monitored more easily than with some other anticoagulants such as Brilinta; therefore, it may offer a safer option when rapid control over coagulation status is necessary.
How effective are both Brilinta and Heparin?
Both ticagrelor (Brilinta) and heparin are powerful anticoagulants with established histories of aiding in the prevention and treatment of thrombotic events. Brilinta was approved by the FDA in 2011, while heparin has been used clinically for over a century. They act via different mechanisms; Brilinta blocks platelet aggregation by inhibiting P2Y12 adenosine diphosphate receptors, while heparin augments the activity of antithrombin III to reduce coagulation.
Their effectiveness has been directly compared in several clinical trials. For instance, a study published in the New England Journal of Medicine in 2009 found that Brilinta showed superior efficacy to clopidogrel (a drug similar to heparin) at preventing cardiovascular death, heart attacks or stroke without increasing major bleeding risk when given along with aspirin.
A meta-analysis conducted on Brilinta studies concluded its benefits outweigh its risks for patients with acute coronary syndrome or those undergoing percutaneous coronary intervention procedures. It is generally well-tolerated but can lead to side effects like breathlessness due to an increase in uric acid levels.
On the other hand, unfractionated heparin (UFH), one form of heparin medication typically administered intravenously or subcutaneously, remains a standard treatment option particularly for venous thromboembolism and during certain heart surgeries because it can be reversed if necessary by protamine sulfate administration. However, it requires close monitoring as overdosage can cause bleeding complications. Low molecular weight Heparins such as Enoxaparin have less need for monitoring but still carry potential risk for bleeding.
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At what dose is Brilinta typically prescribed?
Oral dosages of Brilinta typically start at 180 mg as a loading dose, followed by 90 mg twice daily. Studies have shown this regimen to be effective for preventing thrombotic cardiovascular events in most adults with acute coronary syndrome or a history of myocardial infarction. For Heparin, the dosage is very patient-specific and depends on the condition being treated. It’s usually administered intravenously or subcutaneously under medical supervision. The dosage can be adjusted based on laboratory blood tests such as the activated partial thromboplastin time (aPTT). Always follow your healthcare provider's instructions carefully when taking these medications.
At what dose is Heparin typically prescribed?
Heparin treatment is usually initiated with a loading dose of 5000 units either intravenously (IV) or subcutaneously. Following the initial dosage, maintenance doses are typically between 10,000 to 20,000 units over a period of 24 hours for most adults. The amount can then be adjusted based on laboratory results such as activated partial thromboplastin time (aPTT). Heparin must be given every eight hours when administered subcutaneously and continuously if provided through an IV drip. It's crucial to note that heparin therapy should always be closely monitored by a healthcare professional due to its potential risk of bleeding complications.
What are the most common side effects for Brilinta?
Common side effects of Brilinta may include:
- Nausea
- Dyspnea (difficulty breathing)
- Headache
- Cough
- Dizziness
On the other hand, Heparin can potentially cause:
- Bleeding complications, including blood in urine or stools, and bleeding gums.
- Thrombocytopenia (low platelet count), which might lead to bruising and slow clotting after injury.
- Skin irritation or skin rash at the injection site.
If you experience any of these symptoms while taking either medication, seek medical assistance immediately.
Are there any potential serious side effects for Brilinta?
When weighing Brilinta against Heparin, consider the following possible serious side effects:
- Unusual or unexpected bleeding: this includes blood in your urine or stools, coughing up blood, vomiting that looks like coffee grounds, nosebleeds, and heavy menstrual periods.
- Signs of allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- Chest pain spreading to your jaw or shoulder with nausea and sweating.
- Shortness of breath even with mild exertion
- Swelling in the hands or feet;
- Rapid heartbeat,
- Lightheadedness
-Signs of a stroke - sudden numbness on one side of the body (especially face), confusion , slurred speech , vision problems (blurred/double) , loss of balance/coordination
-Severe headache followed by dizziness/fainting
-The presence thrombocytopenia purpura syndrome symptoms – fever , weakness / fatigue , purple spots under skin
If you experience any these adverse reactions while on either drug it is critical to seek immediate medical attention.
What are the most common side effects for Heparin?
Heparin, another common blood thinner, can cause a variety of side effects. These may include:
-
Mild pain or redness at the injection site
-
Nausea and vomiting
-
Upset stomach and bloating
-
Headaches, dizziness and sweating
-
Anemia (low red blood cell count)
-
Osteoporosis with long-term use More serious but rare side effects may include:
- Thrombocytopenia (low platelet count), leading to increased risk of bleeding
- Allergic reactions including rash, itching/swelling (especially in the face/tongue/throat)
- Severe dizziness, trouble breathing
These are not all the possible side effects. Always consult your healthcare provider for any unexpected or worsening symptoms while on Heparin.
Are there any potential serious side effects for Heparin?
Heparin is a common anticoagulant used to prevent blood clots. However, it's important to be aware of its potential side effects. These could include:
- Signs of an allergic reaction such as rash, itching, swelling especially of the face or throat, severe dizziness, and trouble breathing.
- Unusual bleeding or bruising.
- Blood in the urine or stools.
- Blurred vision and headaches.
- Confusion or changes in mental status like hallucinations and mood swings
- Rapid heart rate (tachycardia).
If you experience any unusual symptoms while taking heparin, contact your healthcare provider immediately.
Contraindications for Brilinta and Heparin?
Both Brilinta and Heparin, like most antithrombotic medications, can increase the risk of bleeding. If you notice any unusual bruising or bleeding that doesn’t stop (like nosebleeds or gums that bleed more than usual), dark urine or stools, fatigue, dizziness or weakness, please seek immediate medical attention.
Neither Brilinta nor Heparin should be taken if you are taking other certain types of medication without consulting your doctor; these may include drugs such as antiplatelet agents (like aspirin), anticoagulants (e.g., warfarin) and some nonsteroidal anti-inflammatory drugs (NSAIDs). Always inform your physician about all the medications and supplements you are taking to prevent dangerous interactions with either Heparin or Brilinta.
Unexpected withdrawal from Brilinta in particular can increase the risk of heart attack or stroke - it is important not to suddenly stop this medication unless advised by a healthcare professional.
How much do Brilinta and Heparin cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Brilinta (90 mg) averages around $400, which works out to about $13–$26 per day, depending on your dose.
- The price for 10 vials of Heparin (1000 units/mL) averages at about $50, working out to approximately $5-$10/day.
So if you're in the higher dosage range for Brilinta (i.e., 180 mg/day), then brand-name Heparin is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which one is right for you: side-effects, medical history and drug-drug interactions are also critical factors.
Currently there are no generic versions available for Brilinta (ticagrelor). For heparin though, costs can vary but typically remain much lower than those associated with branded medications:
- Heparin injections are available in various strengths ranging from 1,000 to 25,000 units/ml. Prices will depend upon the strength required and quantity but usually start as low as $20 up to around $80.
Popularity of Brilinta and Heparin
Ticagrelor, known by the brand name Brilinta, is an antiplatelet drug that was prescribed to approximately 1.5 million patients in the United States in 2020. Ticagrelor inhibits platelets from clumping together and forming blood clots. It's commonly used alongside aspirin as a dual therapy approach for preventing heart attack or stroke in people with acute coronary syndrome or those who have had a previous heart attack.
On the other hand, heparin is one of the oldest anticoagulants still widely used today and has been on WHO’s List of Essential Medicines for years now. Heparin prevents formation of new blood clots and increases clot breakdown - it doesn't thin existing blood clots but rather stops them from growing bigger while your body naturally dissolves them over time. In comparison to ticagrelor's prescriptions, heparin was administered to tens of millions patients across various hospital settings throughout 2020 due to its broad usage spectrum ranging from prevention & treatment of venous thrombosis, pulmonary embolism to maintaining patency during dialysis procedures etc., making it more prevalent than ticagrelor overall despite being primarily hospital-based medication compared to Brilinta which can be taken at home.
Conclusion
Both Brilinta (ticagrelor) and heparin have established records of usage in patients with conditions related to blood clotting, such as angina or heart attack. They are supported by multiple clinical studies indicating their effectiveness over placebo treatments. In some instances, the two drugs may be used together under careful medical supervision since they act differently - Brilinta works by preventing platelets from clumping and forming a new blood clot, while heparin thins the blood to prevent existing clots from getting bigger.
Brilinta is generally considered for use following a heart attack or stroke, whereas heparin would typically be administered during hospitalization for acute coronary syndrome or deep vein thrombosis. Both drugs require regular monitoring due to potential bleeding risks.
Available in both brand-name and generic forms, these medications can offer cost savings especially for those paying out-of-pocket. However, because they deal with critical cardiovascular events, it's important that patients don't stop taking them without consulting healthcare providers first.
The side effect profile between the two includes increased risk of bleeding but varies based on individual patient health profiles and treatment duration. As these medications relate directly to cardiovascular health and carry significant risks if not properly managed, all changes should be monitored closely under medical supervision.
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Refrences
- Reilly, B. M., Raschke, R., Srinivas, S., & Nieman, T. (1993, October). Intravenous heparin dosing. Journal of General Internal Medicine. Springer Science and Business Media LLC.http://doi.org/10.1007/bf02599634
- Walenga, J. M., & Bick, R. L. (1998, May). Heparin-Induced Thrombocytopenia, Paradoxical Thromboembolism, And Other Side Effects Of Heparin Therapy. Medical Clinics of North America. Elsevier BV.http://doi.org/10.1016/s0025-7125(05)70015-8
- Dhillon, S. (2015, February). Ticagrelor: A Review of Its Use in Adults with Acute Coronary Syndromes. American Journal of Cardiovascular Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40256-015-0108-5