304. Anticoagulants Flashcards
What are the different types of anticoagulants and one example
LMWH- Dalteparin, enoxaparin
Unfractioned heparin
Warfarin
DOAC- Rivaroxaban, apixaban, dabigatran
Fondaparinoux- own class Xa inhibitor, used in coronary syndromes
Discuss the actions of LMWH
Xa inactivator (hence the name rivoro Xa parin). Better half life than heparin so can be given less and less side effects
Given to treat VTE’s
How does unfractioned heparin work
Binds to antithrombin (inhibiting thrombin, facor Xa and IXa),
monitor and adjust dose with APTT
When is warfarin used and what do we need to know about it?
Contraindications
Used in longterm anticoagultaion.
Monitored using INR
Warfarin inhibits vitamin K
Contraindications: Peptic ulcer, bleeding disorders, severe hypertension, pregnancy
DOAC’s are great drugs. How do they work and what is their indication?
Do not require regular monitoring
Rivoroxaban and apixaban-factor Xa inhibitors
Dabigatran thrombin inhibitor
Contraindicated in severe renal/ hepatic impairment, active bleeding, reduced clotting factors
How long after commencing warfarin do you monitor the INR
Day 3
What is the reversing agent for dabigatran
Monoclonal antibody- idarucizumab
What is the reversing agent for unfractionated heparin
Protamine sulphate
How do you manage those who have an INR over 5 but below 8 on warfarin
No bleed- withhold 1-2 doses. restart warfarin at a lower dose when INR<5
Bleed- Stop warfarin adn admit for Vit K. Restart at lower dose when <5
For those with an INR over 8 on warfarin how are they managed
No bleed- Stop warfarin, get heam involved
Bleed- stop warrfarin, admoit for vit k. Repeat daily INR and keep giving Vit K. Restart at lower dose when INR<5
If someone is having a major bleed on warfarin how are they managed?
Stop warfarin
give prothrombin complex (FFP if prothrombin unavailable)
5-10mg vitamin K IV
Get heamatology involved
