Anticiuagulants Flashcards
Job of factor X
Conversion of prothrombin to thrombin
Job of thrombin
Conversion of fibrinogen to fibrin
Unfractionated heparin mode of administration
I.V or S.C
Unfractionated heparin mechanism of action
Binds to anti thrombin 3 forms heparin-anti thrombin 3 complex that irreversibly inactivates thrombin and factor X
What should be monitored when giving Unfractionated heparin
aPTT N:1.5-2.5
Unfractionated heparin is given iV in the prophylaxis and acute treatment of
DVT and PE
Unfractionated heparin is given IV to people in the setting of
Acute MI
Unfractionated heparin prophylaxis is given to people with high risk who are
- returning from recent major surgery
- immobilized in the hospital
- pregnancy (S.C heparin)
Unfractionated heparin adverse effects
- bleeding
- heparin induced thrombocytopenia (HIT)
- paradoxical thrombosis
- hyperkalemia
- osteoporosis
Unfractionated heparin antidote
Protamine sulfate
list LMWH
Suffix parin
Dalteparin
Enoxaparin
Nadroparin
LMWH mechanism of action
Same mechanism as Unfractionated heparin but only inhibits factor X
Differences between LMWH and Unfractionated heparin
- doesn’t get inhibited by protamine sulfate
- greater half life so less dosing
- doesn’t require aPTT monitoring
- LMWH eliminated renally, heparin in the liver (so used in renal failure)
- less likely to cause HIT
Fondaparinux mechanism of action
Binds to anti thrombin 3 inhibiting factor X
Which one from the heparin have the lowest risk of HIT
fondoparinux
What’s the heparin of choice during pregnancy
LMWH
Fondaparinux antidote
Idarucizumab
Bivalirudin and dabigatranf mechanism of action
Direct thrombin inhibitors
When are argarotraban and dabigatran used
Used in hit
Rivaroxaban and apixaban mechanism of action
Direct factor X inhibitors
Mode of administration of XABANs
Oral
Mode of administration of bivalirudin and dabigatran
Oral
Rivaroxaban and apixaban indications
- Long term anticoagulation of atrial fibrillation to prevent stroke
- to prevent DVT after hip or knee surgery
What is used in atrial thrombosis
Platelet inhibitors
What is used in venous thrombosis
Anticoagulants
Fondaparinux and LMWH indications
Prevention of DVT After othopedic/abdominal surgery and restricted motility also treatment of DVT and PE
What is used in coronary angioplasty procedures in patients with high risk of HIT
bivalirudin and argatroban
Warfarin mechanism of action
Inhibits vitamin K reductase affecting the synthesis of factors 2. 7, 9 and 10
What do you need to monitor in patients taking warfarin
INR N:2-3
Warfarin indications
Prevention of thrombotic and embolus strokes, patients with mechanical heart valves and venous thromboembolism and PE
Warfarin adverse effects
Skin necrosis, teratogenic, haemorrhage and bleeding
How to treat warfarin toxicity
Administer vitamin K
Attenuation(reduction) of anticoagulation by warfarin
C-C-COS Carbamazepine Chronic alcohol ingestion Cholestyramine Oral contraceptives ST john wart I
