Anticoagulant 20 Flashcards
What is the indication, monitoring for argatroban?
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
What are the indications for Dabigatran?
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
Idarucizumab reversal
dabigatran
Advantages of direct thrombin and Xa inhibtiors?
Equivalent antithrombotic, lower bleeding rates compared with warfarin
Rapid therapeutic effect
No monitoring!
Fewer drug-drug interactions
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?
direct xa and direct thrombin inhibitors
What do fibrinolytic agents activate?
Activate plasminogen-plasmin system, ↑plasmin within thrombi causing rapid lysis.
What are the indications for thrombolytic agents?
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
Indications fo streptokinase
life threatening PE, STEMI
Contraindications and SE of streptokinase
Not recommended in ischemic stroke,
Use of rt-PA
Alteplase (recombinant tissue plasminogen activator; rt-PA).
Indications: Acute ischemic stroke, without hemorrhagic infarct (within 3 hours of symptom onset).
Contraindications of ateplase
Not antigenic (endogenous). Binds to newly formed thrombi with high affinity. Contraindicated in recent hemorrhagic stroke
Half-life and adminstering of tenecteplase and reteplase
longer 1/2 life, 1-2 IV boluses
Fibrinonlytic agents are contraindicated in?
Active internal bleeding
Recent cerebral vascular accident, IC or intraspinal surgery
IC neoplasm
Malignant hypertension (overt organ damage)
What is the m.oa of aspirin/ irrerversible or reversible?
Inhibits platelet aggregation by irreversibly acetylating and inactivating COX, TXA2.
TXA - Function, location, effect on bleeding time, etc
TXA2 causes platelets to change shape, release granules, aggregate (thrombogenesis) and induce vasoconstriction, with ↑bleeding time.
What is the therapeutic goal and, how long does the action lase, dose?
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
What is the indication for aspirin?
Antithrombogenic agent for 2o prevention of acute coronary syndromes and stroke.
