Anticoagulant & Antiplatelet Drugs Flashcards
Which anticoagulation therapy drug is not safe in pregnancy?
Warfarin
It has pretty much 100% absorption, so it’ll cross the placenta
For heparin in general, what does it target?
Heparin targets Antithrombin III
Unfractionated binds antithrombin III and thrombin.
LMWH binds only antithrombin III
What is heparin reversed by?
Protamine-harvested from salmon sperm. yummy
Why is LMWH preferred over unfractionated heparin?
It doesn’t have to be monitored and there’s less thrombocytopenia. Unfractionated works faster and can be completely reversed, but LMWH is still preferred
What is heparin generally useful for in terms of treatment?
Unstable angina/Acute MI
What is the target of warfarin and how long does it take to actually reach maximum effect?
It inhibits Vitamin K to stop the coagulation cascade. It takes 3-5 days to have its effect, so you need to use a heparin bridge.
T or F?
Warfarin is parenteral, heparin is an oral drug.
False
Heparin is parenteral, warfarin is oral
In what clinical condition is warfarin typically used?
Atrial fibrillation-the stasis in the atrium could lead to clotting.
What are some of the negatives of warfarin?
There’s a variability in dosage, you have to monitor the INR, there are lots of drug interactions, and there are dietary limitations related to vitamin K
What is the mechanism of action of dabigatran and why is it better than warfarin?
Dabigatran specifically targets thrombin (Factor IIa).
It’s better than warfarin because it doesn’t require frequent monitoring or dosage adjustments. There are also less drug drug interactions.
When should someone be taking dabigatran and what are some of the negatives?
It should be used in Afib that doesn’t involve mitral valve disease.
Disadvantages are that you have to take it twice daily, it is shorter acting, and it can be tricky for people with renal problems (b/c it’s excreted renally)
What is the target of the -xaban drugs and when are they useful?
They target factor Xa.
They are useful in non-valvular Afib.
*there’s no antidote for these drugs though
What are some of the adverse effects of the xaban drugs?
Increased risk of bleeding.
The anticoagulant effect is difficult to reverse
So it sounds like the Direct-Acting oral Anticoagulants are a lot better than warfarin. Why is warfarin still popular?
It’s cheaper.
It’s safer for valvular disease Afib.
Patients less likely to comply to having to take 2 daily (which they have to for the DOACs)
Better for people w/ kidney disease.
T or F?
The -xamab drugs are preferred over dabagatran
False
There’s no evidence proving one to be better than the other.
