Easing Nigeria’s Burden of Cardiovascular Diseases with Anticoagulants


Easing Nigeria’s burden of cardiovascular diseases with anticoagulants
structural image of the heart

It is often incredible when the news of the sudden demise or disability of a loved one filters into the ears of relatives, who had no prior information of his or her hospitalization due to an accident or illness. In such instances, especially when someone slumps and dies or develops a stroke, it is commonplace for Africans to attribute the incident to witchcraft activities or demonic attacks. However, medical experts have associated such occurrences with cardiovascular diseases, which are termed, silent killers.

Cardiovascular diseases (CVDs) include any disorder, abnormality, or failure to function well, relating to the heart and blood vessels or the circulatory system. Previously, such ailments were common among older adults from 50 years above, but recent findings have shown that younger adults from 35 years old and above have more and more risk factors for heart diseases, due to changes in lifestyle.

Recent reports from the World Health Organisation show that an estimated 17.9 million people died from CVDs in 2019, representing 32 percent of all global deaths. Of these deaths, 85 percent were due to heart attack and stroke. The findings also revealed that over three-quarters of CVD deaths take place in low- and middle-income countries.

This explains the need for awareness creation among patients and practitioners because knowledge and experience have shown that heart diseases are preventable and reversible when identified early.

Critical risk factors

While it has been observed that advocacy on the management of high blood pressure and blood glucose level is gaining ground, much is not heard about other risk factors that predispose people to CVDs, which include certain heart or blood vessel diseases; an abnormal heart rhythm called atrial fibrillation; a heart valve replacement; blood clots after surgery; and congenital heart defects.

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Notable among other risk factors for heart failure and stroke is an abnormal heart rhythm and blood clots. Cardiologists have linked an abnormal heart rhythm or atrial fibrillation (AF) with considerable morbidity, including an increased risk of cognitive impairment, a three-fold increase in the risk of heart failure, and a five-fold increase in the risk of stroke.

Findings have also shown that people have different tendencies for blood clots, such as cancers, those who have undergone major surgery, family history, obesity, prolonged immobility, long-distance traveling by flight, and those who sustain long bone fractures, just to mention a few.

According to Dr. Dike Ojji, consultant cardiologist, Department of Internal Medicine, College of Health Sciences, University of Abuja and University of Abuja Teaching Hospital, 20 percent of all strokes in the general population are due to AF, while non-valvular atrial fibrillation is associated with increased severity, disability, and an increased risk of death.

A simple analysis of the population of Nigerians susceptible to morbidity and mortality through these risk factors highlighted above, with the attendant economic burden, gives an urgent call for early diagnosis and proper management of AF and blood clots through the administration of anticoagulants.

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Necessity of anticoagulants

Anticoagulants or blood thinners are medicines that prevent blood clots from forming. While they do not break up already formed clots, they can stop those clots from getting bigger. As identified above as one of the risk factors for heart attacks, strokes, and blockages, the treatment of blood clots is essential.

It is also worthy of mention that sensitization on the usage of anticoagulants is at a low ebb in the country, as some cardiovascular patients sampled on the knowledge of anticoagulants responded negatively when compared with their knowledge of other drugs like antihypertensives, antidiabetics, and diuretics.

Heart and Stroke Foundation of Canada listed examples of anticoagulants to include Eliquis, a brand of apixaban; Pradaxa, made from dabigatran; Lixiana, a form of edoxaban; Rivaroxaban, a brand of Xarelto; and Warfarin, made from coumadin. There are other brands, depending on the healthcare provider’s prescription. It is however pertinent for patients to know the uniqueness of each brand, as well as its side effects.

For instance, practitioners have revealed the flexibility in the administration of Eliquis, a newly launched anticoagulant by a leading multinational pharmaceutical company, Pfizer Inc, as it can be taken with or without food. The tablet may also be crushed and mixed with water, or 5 percent glucose in water, or apple juice, immediately before the drug is taken, which makes it very easy for patients to swallow.

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It goes without saying that, with such advancement in the production of Eliquis and other anticoagulants, cases of stroke and blood clots should be reduced to the barest minimum in the country. They have been used to prevent blood clots from forming in the heart of patients with irregular heartbeats and at least one additional risk factor.

Medical literature affirms that blood clots may break off and travel to the brain and lead to a stroke or to other organs and prevent normal blood flow to that organ (also known as a systemic embolism).

From the point of view of Dr. Agoke Adekunle, consultant cardiologist, Federal Medical Centre Owo, “It is very important that when certain disease conditions which can lead to stroke are suspected, efforts must be put in place to begin early treatment. For instance, people who have AF must be risk-stratified soonest to begin the blood thinners that may help.

“Also in the society at large, cutting down on weight if obese, avoiding prolonged immobilization by initiating early ambulation if admitted on beds, will go a long way in mitigating blood clot, aside from the usage of anticoagulants.”

To mitigate the social and economic burden of stroke and heart failure in the country, it is imperative for practitioners to note the role of anticoagulants in reducing the occurrence of two forms of ischemic stroke, thrombotic and embolic stroke.


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