Anticoag Flashcards by Rohit Sampat

What can increase bleed risk when given with anticoagulants?

NSAIDs

SSRIs

fish oil

garlic, ginger, ginkgo, ginseng, glucosamine

willow

grapefruit

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Heparin route of admin

IV or SubQ (NOT IM = hematoma)

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Heparin SE

increased AST

thrombocytopenia/HIT

bleeding

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Heparin antidote

protamine

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Enoxaparin dosing

generally 1 mg/kg
QD for prevention

BID for treatment

renal dosing: 30 mg qd

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Enoxaparin antidote and monitoring

protamine

Maybe monitor antiXa but not always req.

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Warfarin full effect in how many days?

6 days

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VItamin K effect on Warfarin

Vit K DECREASES Warfarin

decreases INR

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When to avoid Warfarin?

HIT patients

with Amiodarone or NSAIDs

CYP2C9 genetic variation or CYP3A4 interactions

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Warfarin antidote?

Vitamin K

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Warfarin INR goals

2-3 for normal range

2.5 - 3.5 for mitral valve pts

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Increased Bleed Risk with Warfarin

amiodarone

zafirlukast

Azoles
Bactrim
Macrolides(zpak)
Tetracycline
FQs
PCNs

etravirine

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Drugs that decrease INR

carbamazepine

phenytoin

phenobarbital

rifampin

aprepitant

St Johns

primidone

vit K

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Black Box for dabigatran or bivlirudin

Epidural = hematoma = paralysis

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Pradaxa generic

dabigatran

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What anticoagulant can HIT patients take?

IV argatroban

fondaparinux

Pradaxa antidote

Praxbind

Argatroban antidote

NONE

Dabigatran notes

BID for tx

QD for prevention

**P-glycoprotein so avoid w/ **
carbamaz
rifamp
dexamethasone
St Johns

Xarelto generic

rivaroxaban

Eliquis generic

apixaban

Savaysa generic

edoxaban

Arixtra generic

fondaparinux

fondaparinux antidote and monitoring?

No antidote

Monitor platelets and antiXa

Anticoag safe in pregnancy?

fondaparinux

What is HIT?

Unexplained 50% drop in platelets. Treat w/ vit K D/C all heparins, start argatroban. Wait for warfarin until platelets come back up (use together x 5 days)

Antiplatelet therapies

(PO only) Plavix Effient Brillinta

Plavix generic

clopidogrel

Effient generic

prasugrel

Brillinta generic

ticagrelor (ok to crush, use in NG tube)

CYP2C19 Med

clopidogrel - requires this enzyme for activation

Fatal SE of clopidogrel

TTP = thrombotic thrombocytopenic purpura

When to D/C anticoags vs antiplatelets before procedure

24 hrs for anticoag (Xarelto) | 5 days for Plavix

Downsides to Effient

More bleeding than Plavix Can't use in > 75 yo no antidote (same for plavix) Contra for TIA/past stroke

IV Platelet Aggregation Inhibitors

abciximab (Reopro) *irreversible eptifibatide (Integrilin) tirofiban (Aggrastat)

Fibrinolytic Notes

STEMI only. IV only *must get within 30 mins of heart attack/hospital arrival alteplase, reteplase, tenecteplase