Anticoagulant 20

Question 1

What is the indication, monitoring for argatroban?

Answer 1

Short t1/2
Indication: tx or prophylaxis of HIT with or without thrombosis, coronary angioplasty with HIT
Monitor aPTT. High INR, difficult transition to warfarin

Question 2

What are the indications for Dabigatran?

Answer 2

prevention of stroke and systemic embolism in non-valvular Afib
VTE following 5-7 days tx with heparin/LMWH
↓risk of recurrent VTE
VTE prophylaxis in major orthopedic surgery

Question 3

Idarucizumab reversal

Answer 3

dabigatran

Question 4

Advantages of direct thrombin and Xa inhibtiors?

Answer 4

Equivalent antithrombotic, lower bleeding rates compared with warfarin
Rapid therapeutic effect
No monitoring!
Fewer drug-drug interactions

Question 5

MRS H, has been on these drugs for years, However, due to the passing of her husband she has not been adhering to her med schedule, She now presents with a DVT after 1 wk of missing her medication, what possible medications can she be taking? (Hint- a similar effect to warfarin fewer effects?

Answer 5

direct xa and direct thrombin inhibitors

Question 6

What do fibrinolytic agents activate?

Answer 6

Activate plasminogen-plasmin system, ↑plasmin within thrombi causing rapid lysis.

Question 7

What are the indications for thrombolytic agents?

Answer 7

Acute MI (careful patient selection: STEMI, bundle branch block)
Massive PE
Thrombosis of central catheters
DVT
Acute peripheral arterial occlusions
Another venous thrombosis
Central DVT – superior vena cava syndrome

Question 8

Indications fo streptokinase

Answer 8

life threatening PE, STEMI

Question 9

Contraindications and SE of streptokinase

Answer 9

Not recommended in ischemic stroke,

Question 10

Use of rt-PA

Answer 10

Alteplase (recombinant tissue plasminogen activator; rt-PA).
Indications: Acute ischemic stroke, without hemorrhagic infarct (within 3 hours of symptom onset).

Question 11

Contraindications of ateplase

Answer 11

Not antigenic (endogenous). Binds to newly formed thrombi with high affinity. 
Contraindicated in recent hemorrhagic stroke

Question 12

Half-life and adminstering of tenecteplase and reteplase

Answer 12

longer 1/2 life, 1-2 IV boluses

Question 13

Fibrinonlytic agents are contraindicated in?

Answer 13

Active internal bleeding

Recent cerebral vascular accident, IC or intraspinal surgery

IC neoplasm

Malignant hypertension (overt organ damage)

Question 14

What is the m.oa of aspirin/ irrerversible or reversible?

Answer 14

Inhibits platelet aggregation by irreversibly acetylating and inactivating COX, TXA2.

Question 15

TXA - Function, location, effect on bleeding time, etc

Answer 15

TXA2 causes platelets to change shape, release granules, aggregate (thrombogenesis) and induce vasoconstriction, with ↑bleeding time.

Question 16

What is the therapeutic goal and, how long does the action lase, dose?

Answer 16

Therapeutic goal: inhibit TXA2, without PGI2 (prostacyclin which is an anti-aggregatory mediator).

Action lasts for the 8-10 day lifespan of affected platelet.

Therapeutic dose 40-1000mg/d; additive effect with heparin

Question 17

What is the indication for aspirin?

Answer 17

Antithrombogenic agent for 2o prevention of acute coronary syndromes and stroke.