By Chioma Obinn

Despite the disruption caused by the COVID-19 Pandemic in healthcare systems globally, cardiovascular diseases (CVDs) remain the leading cause of death globally, killing an estimated 17.9 million persons each year, according to the World Health Organisation statistics.  CVDs are a group of disorders of the heart and blood vessels. Worst still, findings have also shown that more than four out of five CVD deaths are due to heart attacks and strokes.

For instance, a study published in the National Library of Medicine by Kolawole Wasiu showed that the current prevalence of stroke in Nigeria is 1.14 per 1000 while the 30-day case fatality rate remains as high as 40 per cent. Sadly, management of the disease is largely conservative and there is little or no funding for high-quality research.

Hence, primary prevention is the key to reducing the burden of the disease in a country like Nigeria with poor resources.

According to a Consultant Cardiologist, at Lagos State University Teaching Hospital, Dr Ramon Moronkola, strokes or heart attacks don’t just occur; blood clots and other blockages play a role. When the heart is in normal rhythm, blood flows briskly through each chamber. In a condition called atrial fibrillation (Afib), blood has more opportunity to pool in the top chambers of the heart.

Blood clot

With less movement, blood is more prone to clotting. Once clots form, they can be pumped out of the heart and into the body’s arterial system. This can cause a stroke.

Blood clots also play a major role in heart attacks. Over time, the coronary arteries can develop plaques. Smoking, high blood pressure, high cholesterol, and diabetes are risk factors for atherosclerosis; over time, they cause injury to the blood vessels and lead to more plaque formation.

In deep vein thrombosis (DVT), blood clots develop in the leg or pelvis veins. If a portion of the DVT dislodges, it can travel through the veins and eventually reach the pulmonary arteries, becoming a pulmonary embolism (PE).

However, Moronkola explained that some of these can be prevented with anticoagulants also known as blood thinners.

He said these medicines are very useful in the treatment and prevention of a type of stroke and heart attack in a group of patients.

The Consultant Cardiologist said anticoagulants can help keep the blood from clotting easily by interfering with the blood clotting process. They are also used for preventing ischemic stroke (the most common type of stroke) and ministroke.

 “Anticoagulants are used for prevention of venous thrombosis ( DVT, PE) in patients at risk or for treatment of established venous thrombosis.

“A patient that has a stroke and can’t move his legs is at risk of developing DVT and may have to be on anticoagulants. But these drugs should only be used when prescribed by a medical doctor.”

He maintained that anticoagulants were very useful at any point there was a risk for thrombosis. He said the drugs are used to prevent a serious situation of cardiovascular diseases.

Who needs anticoagulants?

Just like the World Health Organisation, WHO suggested that low doses of anticoagulants be used for the hospitalised patients to prevent the blood clots forming in blood vessels, these drugs have also been recommended for thrombotic event prevention in many cardiovascular diseases, including stroke prevention in atrial fibrillation, treatment and secondary prevention of acute coronary syndrome, heart valve replacement, risk of blood clots after surgery, congenital heart defects among others.

In the views of a Consultant Cardiologist, Department of Internal Medicine, College of Health Sciences, University of Abuja & University of Abuja Teaching Hospital, Gwagwalada, Dr Dike Ojji, Non-Valvular Atrial Fibrillation (NVAF) increases the risk of stroke by approximately 5-fold compared to the risk of stroke in patients without NVAF.

Ojji said it is also associated with increased severity, disability, and an increased risk of death with a 30-day mortality rate of 33 per cent (vs. 16 per cent for non-AF strokes) and a 1-year mortality rate of ~50 per cent.

 He explained that 20 per cent of all strokes in the general population are due to Atrial Fibrillation, adding that, apixaban demonstrated superior efficacy versus ASA without significantly increasing the risk of major bleeding, and apixaban demonstrate a superior stroke/systemic embolism prevention by 21 per cent, Superior profile in reducing major bleeding by 31 per cent and Superior reduction in all-cause mortality by 11 per cent versus warfarin.

However, Pfizer’s Eliquis is one of the anticoagulants used for the prevention of blood clots from forming and contains the active substance apixaban.

These drugs are also known as blood thinners do not break up clots that you already have but stop those clots from getting bigger.

Ojiji said it was important to treat blood clots because clots in the blood vessels and heart can cause heart attacks, strokes, and blockages.

Eliquis is used in adults to prevent a blood clot from forming in the heart of patients with an irregular heartbeat (atrial fibrillation) and at least one additional risk factor.

This is because 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).


A stroke can be life-threatening and requires immediate medical attention.

It is also sued to treat blood clots in the veins of the legs and in the blood vessels of the lungs (pulmonary embolism), and to prevent blood clots from re-occurring in the blood vessels of the legs and/or lungs.

The drug can be taken with or without food and should be swallowed with a drink of water.

“The tablet may also be crushed and mixed with water, or 5 per cent glucose in water, or apple juice, immediately before the drug is taken.

“Eliquis should be taken as recommended to prevent a blood clot from forming in the heart in patients with an irregular heartbeat and at least one additional risk factor.  It recommended dose is one tablet of Eliquis 5 mg twice a day.

The recommended dose is one tablet of Eliquis 2.5 mg twice a day if the patient has severely reduced kidney function, a blood test result that suggests poor kidney function, age of 80 years old or older; and if the weight is 60 kg or lower.

 For preventing blood clots from re-occurring following completion of six months of treatment, the recommended dose is one tablet of Eliquis 2.5 mg twice a day, for example, one in the morning and one in the evening.


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