Anti-Coags

Question 1

What are the therapeutic and prophylactic indications of anticoagulants ?

Answer 1

Therapeutic: venous thromboembolic disease, DVT and PE
Prophylactic: prevention of DVT or PE, prevention of stroke

Question 2

Give an example of a Low molecular weight heparin and what it is used for?

Answer 2

e.g dalteparin, enoxaparin
- prevention and initial treatment of thromboembolism
-it accumulates in renal failure

Question 3

What does unfractionated heparin do (UFH) ?

Answer 3

• IV or SC
• binds atithrombin which increases its ability to inhibit thrombin, factor xa and IXa

Question 4

What are the side effects of LMWH and UFH?

Answer 4

• increased bleeding at operative site, heparin induced thrombocytopenia, osteoporosis

Question 5

What are the contraindications for both LMWH and UFH?

Answer 5

bleeding disorders, low platelets, peptic ulcer, severe hypertension, neurosurgery

Question 6

When is warfarin used and what are its contraindications?

Answer 6

• long term anticoag
  -inhibits reductase enzyme that forms vitamin K
  -CI: peptic ulcers, bleeding disorders, severe hypertension, pregnancy

Question 7

Give example of a DOAC and the CI

Answer 7

e.g Rivaroxaban, apixaban (factor xa inhibition), dabigatran (a direct thrombin inhibitor)
CI: severe liver/ renal impairment, active bleeding

Question 8

How do you start therapeutic anticoagulation?

Answer 8

-usually initially LMWH or UFH
-when transitioning to warfarin, give heparin in combination to start with
- switch from heparin completely if changing to DOAC
- DOAC and warfarin can be initiated as monotherapy in chronic AF