Anti-thrombotics 2 Flashcards
Anti coagulants
Warfarin: inhibits sythesis of clotting factors
errything else: inhibit activity of clotting factors
Classes of anticoags
Vit K antagonist: warfarin
Antithrombin activators: heparin, exonaparin, fondaparinux
Direct Thrombin inhibitors: argatroban, bivalirudin, dabigitran
Direct FXa inhibitors: apixaban, rivaroxaban, edoxaban
Warfarin
Coumadin
For MI, thromboembolisms
BOX: bleeding, need to monitor INR. Want it at: 2-3
Vit K antagonist
Oral tabs are color coded
ADR: bleeding when supratherapeutic INR (almost always)
CONTRA: hemorrhagic tendencies, recent surgery on spine/eyes, HTN, pregnancy
Vitamin K: Pythonadione
Hemorrhage prevention in newborns (intracranial) meh
Warfarin antidote: reverses hypothrombinemia and bleeding
Essential for coagulation cascade
ADR: No storage, metabolized and secreted rapidly
Food and Drug interactions with Warfarin
Vit K containing foods: decrease the INR and effects. SPINACH and KALE and broccoli (leafy green vegetables)
Alcohol, cranberries, cherries, grapefruit: Increase effects
ADR: LOTS. Sulfa-antibs (bactrim): bleeding risk! Acetaminophen: increases INR. Carbamazepine/rifampin/phenobarbital: decrease effects
Warfarin New clots and CHEST guidelines
pts with new DVT or clots, warfarin started same time as parenteral anticoagulation and continued for a MINIMUM of 5 days AND INR greater than 2 for 24 hours or else risk rebound clots.
CHEST: recommend novel oral anticoagulants over warfarin for DVT and PE in non cancer patients. Low weight Heparin over either in cancer pts.
Heparin (unfractionated)
Anticoagulant prophlyactic and treatment. Inactivates thrombin and Xa
Dose: Full dose for treatment. prophylaxis (subQ): 5000 units q8h q12h/ 7500 q8h in morbidly obese.
CONTRA: severe thrombocytopenia, active bleed, Hx HIT
ADR: bleeding, thrombocytopenia, localized rxns in subQ admin = bruise, irritation, hematoma
Heparin Induced Thrombocytopenia (HIT)
Can be fatal
Abs are developed against heparin-plt complexes that damages vascular endothelium, causing an increase in clotting while decreasing PLT
Heparin-PLT Factor IV Ab Test (PF4 ELISA) to confirm. Use Argatroban to treat
Protamine
For Heparin neutralization
BOX: Hypersensitivity
MOA: forms a stable salt with heparin
ADR: Bradycardia, flushing, hypotension
Enoxaparin (Lovenox)
Acute coronary syndromes, DVTs/PEs BOX: Spinal/epidural hematoma Shortened derivative of Heparin CONTRA: hx of HIT, active major bleeding ADR: Anemia and bleeding
Lovenox compared to Heparin
LMWH are just shorter.
As effective as Heparin, easier to administer, less stringent monitoring, longer half life
Full dose: 1mg per kg per 12 or 1.5mg/kg q24
Prevention: 30mg q12 or 40mg q24
Intermediate: 60mg q12 or 1mg/kg q24
Fondaparinux
DVT/PE, VTE prophylaxis Hx of HIT, not active BOX: spinal/epidural hematomas Selective inhibition of Xa CONTRA: severe renal impairment, bleeding, endocarditis ADR: anemia and bleeding
Argatroban
Treatment of thrombosis in pts with HIT or Hx of HIT
Direct inhibition of thrombin
CONTRA: major bleeding
ADR: bleeding and hypotension
Dosed off of bilirubin, monitored with aPTT
Bivalirudin
Anticoagulants in pts undergoing PCI
Direct thrombin inhibitor
CONTRA: active bleeding
ADR: bleeding and hypotension
Dabigatran
DVT/PE treatment and prevention, a fib
BOX: thrombotic events and spinal/epidural hematoma
Direct thrombin inhibitor
CONTRA: bleeding and mechanical heart valves
ADR: Bleeding and GI disturbances
