4.1 Hematologic: Anticoagulants

Question 1

Acute treatment of DVT, PE and AMI

SE: bleeding, thrombocytopenia

Monitor with PTT

Answer 1

Heparin

Question 2

Low molecular weight heparin; less risk of thrombocytopenia

Does not need monitoring

Answer 2

Fondaparinux; enoxaparin

Question 3

Treatment of heparin-induced thrombocytopenia

Answer 3

Lepirudin; argatroban

Question 4

Antidote to heparin-induced bleeding

Answer 4

Protamine sulfate

Question 5

Chronic anticoagulation

SE: bleeding, skin necrosis, many drug interaction

Answer 5

Warfarin

Question 6

Antidote to warfarin (immediate reversal)

Answer 6

Fresh frozen plasma

Question 7

Antidote to warfarin (reversal over time)

Answer 7

Vitamin K

Question 8

Laboratory tests to assess the extrinsic and intrinsic coagulation pathways

Answer 8

PiTT
PTT for intrinsic pathway

PeT
PT for extrinsic pathway

Question 9

Why is an overlap between heparin and warfarin usually done?

Answer 9

Warfarin’s effect requires elimination of preformed clotting factors to bypass the initial prothrombotic effect of warfarin