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Haematology HK > Anticoagulant drugs > Flashcards

Anticoagulant drugs Flashcards

1
Q

indications for anticoagulant drugs

A

VTE recurrent
AF
valve replacement

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2
Q

action of heparin

A

potentiates antithrombin by making the antithrombin-thrombin complex stronger
also acts on factor Xa

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3
Q

what are the 2 types of heparin

A

unfractionated

low molecular weight

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4
Q

when is heparin used

A

acute VTE (DVT, PE)

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5
Q

route for heparin

A

IV/SC

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6
Q

what does unfractionated mostly affect

A

thrombin

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7
Q

what does LMW mostly affect

A

factor Xa

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8
Q

what type of heparin requires monitoring

A

unfractionated

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9
Q

how is unfractionated heparin monitored

A

APTT

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10
Q

how often does APTT need to be checked in unfractionated heparin use

A

every 4-6 hours

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11
Q

why would unfractionated be used over LMWH

A

risk of bleeding eg GI ulcers

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12
Q

when is heparin used long term

A

prophylaxis in pregnancy if at high risk

warfarin is contraindicated in pregnancy

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13
Q

complications of heparin

A

bleeding
thrombocytopenia (monitor FBC, patient collapses within 5-10 days of onset)
osteoporosis if long term

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14
Q

how is heparin reversed

A

stop heparin (half life of half an hour)

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15
Q

if severe bleeding in heparin therapy, what is management and how effective is it

A

protamine sulfate
complete reversal if unfractionated
partial reversal if LMWH

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16
Q

what are coumans

A

warfarin

phenindione

17
Q

action of warfarin

A

inhibits vitamin K which is required to decarboxylate factors 2, 7, 9 and 10 to make them active
warfarin keeps them inactive

18
Q

what else is vitamin K required for

A

protein C and S function

19
Q

during initiation of warfarin, what else should be given and why

A

heparin

proteins C and S are first to be affected by warfarin - become more thrombotic in first few days

20
Q

when should warfarin be taken

A

same time every day (6pm I recommended)

21
Q

what is warfarin metabolised by and why is this important clinically

A

cytochrome P450b enzymes
antibiotics are also metabolised this way - less warfarin metabolised
higher warfarin conc = higher chance of bleed

22
Q

how is warfarin monitored and what is the target

A

using INR

2-3 (higher for mechanical valves)

23
Q

what are minor bleeds

A

epistaxis
haematuria
bruising

24
Q

what are major bleeds

A

GI bleeds
intracerebral bleeds
if drop in BP

25
Q

INR 4.5-6 and no bled

A

reduce warfarin dose

26
Q

INR 6-8

A

stop warfarin

resume when <5

27
Q

INR >8 with no bleed/minor bleed

A

stop warfarin

give vit K

28
Q

how long does Vit K take to work

A

6 hours

29
Q

if INR >8 and major bleed

A

stop warfarin
give beriplex (contains clotting factors)
Vit K
fresh frozen plasma if required

30
Q

how often is INR checked

A

every day on initiation
then alternative days
then weekly

31
Q

signs of warfarin toxicity/overdose (SAFETY NETTING)

A 
blood in stool 
haemoptysis
heavy periods 
blood in urine 
hameatemasis/abdo pain 
purpura/bruising 
bleeding from cuts
nose bleeds 
swollen joints/joint pain
dizziness
vision changes
32
Q

how are patients bleeding risk assessed

A 
HASBLED score 
H - hypertension >160
A - abnormal renal or liver function 
S - stroke history
B - bleeding disposition 
L - labile INR 
E - elderly 
D - drinks >8 alcohol drinks /week, other antibleeding drugs 
>3 points = high risk of bleeding
33
Q

example of thrombin inhibitor

A

dabigatran

34
Q

examples of factor Xa inhibitors

A

rivaroxaban

apixapan

35
Q

advantages of new anticoagulants

A

oral
no monitoring required
less drug interactions

36
Q

disadvantage with new anticoagulants

A

no antidote

Haematology HK (22 decks)

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