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Anaesthetics > Anti-coagulants > Flashcards

Anti-coagulants Flashcards

1
Q

What are indications for anti-coagulants?

A

Atrial fibrillation
VTE
MI
Stroke/TIA

Hypercoagulability disorders

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2
Q

What are some inherited hypercoagubility disorders?

A

Factor V Leiden deficiency
- blood vessels cannot heal normally

Protein C deficiency
- protein C prevents blood clotting

Protein S deficiency
- protein S regulates blood clotting

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3
Q

What are some examples of acquired hypercoagubility?

A

Cancer
Trauma
Immobility

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4
Q

What are the oral anticoagulants?

A

Warfarin

DOACs

  • apixaban
  • rivaroxaban
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5
Q

What are the parental anticoagulants?

A

Heparin

  • UFH
  • LMWH

Heparin alternatives

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6
Q

What is INR?

A

International normalised ratio

INR = patient prothrombin time / control

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7
Q

What is a normal INR?

A

1.1

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8
Q

What INR is required for elective surgery?

A

<1.5

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9
Q

What is the action of warfarin?

A

Vitamin K antagonist

  • inhibits vitamin K epoxide reductase
  • stops conversion of vitamin K to active form
  • vitamin K required for synthesis of factors II, VII, IX, X
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10
Q

What is the absorption of warfarin?

A

Oral bio-availability 79-100%

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11
Q

What is the distribution of warfarin?

A

Protein binding 99%

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12
Q

What organ metabolises warfarin?

A

Liver

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13
Q

What organ excretes warfarin?

A

Kidney

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14
Q

What is the reversal of warfarin?

A

Vitamin K

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15
Q

How long before surgery do you need to stop warfarin?

A

5 days

Check INR

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16
Q

What are the actions of DOACs?

A

Factor Xa inhibitor

17
Q

What is the absorption of DOACs?

A

Oral bio-availability 50-70%

18
Q

What is the distribution of DOACs?

A

Protein binding 87%

19
Q

What organ metabolises DOACs?

A

Liver

20
Q

What organ excretes DOACs?

A

Kidney

Some excreted by bile

21
Q

What is the reversal of DOACs?

A

Andexanet alfa

22
Q

How long before surgery do you need to stop DOACs?

A

24 hours

48 hours if poor renal function

23
Q

What is the action of unfractioned heparin?

A

Inhibits antithrombin III

- antithrombin III activates factors XIIa, XIa, IXa, Xa, IIa

24
Q

What are the low molecular weight heparins?

A

Dalteparin

Enoxaparin

25
Q

What is the action of LMWHs?

A

Inhibit factor Xa

26
Q

What is the absorption of heparin?

A

IV (UFH)

SC (LMWH)

27
Q

What is the distribution of heparin?

A

Plasma volume

28
Q

What organ metabolises heparin?

A

Liver

29
Q

How is heparin excreted?

A

Urine

30
Q

What is heparin reversal?

A

Protamine

  • forms an inactive ion pair with heparin
  • dissociates heparin from ATIII
31
Q

How long before surgery do you need to stop heparin?

A

Heparin stops working after 90 mins

Monitor APTT

32
Q

What is APTT?

A

Activated partial thromboplastin time

Measure of the functionality of the intrinsic and common pathways of the coagulation cascade

33
Q

How long before surgery do you need to stop LMWH?

A

Wait 12 hours - prophylactic dose

Wait 24 hours - treatment dose

34
Q

What are the commonly used anti-platelet agents?

A

Aspirin

Clopidogrel

35
Q

What is the action of aspirin?

A

Reduction of TXA2 synthesis by COX-1 inhibition - inhibits platelet aggregation

36
Q

What is the action of clopidogrel?

A

ADP receptor antagonist

- inhibit activation of GPIIb/IIIa

37
Q

How long before surgery do you need to stop aspirin?

A

Can continue it

38
Q

How long before surgery do you need to stop clopidogrel?

A

Stop 7 days before

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