Anticoagulant Flashcards
What are the two types of clots?
White and Red
What is the main component of white clots, patho of the clot, what types of vessels do we find them in, what pathological condition is most associated with white clots?
Platelets. Platelets adhere to damaged endothelium. High pressure arteries. Local ischemia.
Main component of red clots, what types of vessels do we most commonly find red clots, and what pathological condition do we get from red clots?
Fibrin trapping RBCs, low pressure veins and heart, embolism.
What are the three families of drugs to treat clots?
Anticoagulants, anti-platelets, and thrombolytics
Big picture, when do we use anticoagulants?
To prevent clot formation in the veins and heart, so red clots.
Big picture, when do we use antiplatelet drugs?
To prevent clots in the arteries, so white clots.
Big picture, when do we use thrombolytics?
Restore blood flow after a clot has formed. Bust up the clot.
Big picture what is the MOA for anticoagulants?
Regulate function and synthesis of clotting factors
Two groups of anticoagulants?
Parenteral (indirect and direct thrombin blockers) and oral
What drug are we talking about with indirect thrombin inhibitors and what is its MOA?
Heparin. Increases AT3 activity by 1000 fold.
What are the three types of indirect thrombin and 10 inhibitors and what are their differences in their effects?
HMW: inhibits both thrombin and factor 10
LMW: inhibits factor ten mostly, a little of thrombin
Fonda: only factor 10
What are the two ways we can monitor patients on heparin?
aPTT (intrinsic pathway) and anti 10 assay
2 adverse effects of heparin?
Bleeding and HIT
What is the big picture patho of HIT?
Antibodies attack the heparin-platelet factor 4 complex and activates the platelets, and lead to a pro thrombotic state.
Two big indications for these indirect thrombin inhibitors?
DVT and PE
How does Lepirudin and Bivalirudin bind to thrombin?
Bind at both the active site and the substrate site.
How does Argatroban bind to thrombin?
Only at the active site.
What is the route of administration for indirect thrombin inhibitors and direct thrombin inhibitors?
Parenterally
2 clinical indications for direct?
HIT and angioplasty
What is the most commonly prescribed anticoagulant in US?
Warfarin
What is the MOA for warfarin, 2 things?
- Inhibits vitamin K epoxide reductase
2. Inhibits GGCX from carboxylating clotting factors
What clotting factors are affected by not being able to carboxylate?
2,7,9,10
Which Warfarin isomer is more potent?
S
3 indications for Warfarin?
Treat clots, A fib, and patients with prosthetic heart valves.
What is the adverse effect of warfarin that is specific to a specific patient population?
Teratogenic effect in fetus. Bleeding disorder.
What is the bioavailability of warfarin and what is its state in the blood?
100% bio and mostly bound to albumin.
High chance of thrombosis INR, Normal, chance of bleeding, and warfarin patients INR?
.5, .9-1.3, 4-5, and 2-3
What is responsible for the most variation of Wafarin? What ethnicity is more resistant to warfarin? What ethnicity is less resistant to Warfarin?
The individuals unique reductase. AA. Asians.
4 advantages of using warfarin?
Oral, long action, don’t need kidneys for drug clearance, and reversed by giving vitamin K.
2 main drawbacks to using Warfarin?
Doing incredibly variable which leads to problems and required INR monitoring.
What are the direct oral anticoagulants blocking and what are their 3 clinical uses?
Factor 10 And thrombin
Prevent embolism, treat embolism, and prevent stroke in Afib.
3 advantages of DOAC?
Fixed doses so don’t need monitoring
Equal in efficacy of warfarin
Rapid onset of action
1 drawback of DOAC?
Excreted by kidney so you have to adjust dose for patients with kidney disease
What is the only oral direct thrombin blocker?
Dabigatran
2 clinical indications for dabigatran?
Reduce the risk of embolism in a fib patients and treat venous clots.
What is the disadvantage of dabigatran?
Mostly excreted by the kidneys
What is the antidote for DOAC for factor ten?
A Alfa
What is the antidote for DOAC for thrombin?
Idarucizumab
What blood coag test do we do to monitor heparin?
APTT and anti10
What test do we do to monitor warfarin?
PT based INR
What test do we do to monitor DOAC ten blockers?
Anti 10
What blood test do we do to monitor DOAC thrombin blockers?
Diluted TT
