Anticoagulant medication used for treatment of cardiovascular disease

Question 1

What are the 3 phases of haemostasis?

Answer 1

Vasoconstriction, primary haemostasis (platelet plug), secondary haemostasis (coagulation cascade).

Question 2

What triggers primary haemostasis?

Answer 2

Exposure of subendothelial collagen and binding of vWF.

Question 3

Name two key glycoproteins involved in platelet adhesion and aggregation.

Answer 3

GPIb (binds vWF) and GPIIb/IIIa (binds fibrinogen).

Question 4

What substances are released from platelet granules during activation?

Answer 4

ADP, thromboxane A2, serotonin (5-HT), platelet activating factor.

Question 5

What stabilizes the platelet plug in haemostasis?

Answer 5

Fibrin, converted from fibrinogen by thrombin.

Question 6

What is the function of thrombin in clot formation?

Answer 6

It converts fibrinogen to fibrin and activates factors V, VIII, and XIII.

Question 7

Which coagulation factors are vitamin K-dependent?

Answer 7

Factors II, VII, IX, X and Proteins C, S, Z.

Question 8

What is the intrinsic pathway activated by?

Answer 8

Thrombin-mediated activation of Factors VIII and IX.

Question 9

What is the mechanism of aspirin?

Answer 9

Inhibits COX, reducing thromboxane A2 production and platelet aggregation.

Question 10

What is the mechanism of clopidogrel?

Answer 10

Blocks ADP receptors, reducing platelet activation.

Question 11

What is the mechanism of dipyridamole?

Answer 11

Phosphodiesterase inhibitor that increases cAMP, reducing aggregation.

Question 12

What is abciximab and its function?

Answer 12

A monoclonal antibody that inhibits GPIIb/IIIa receptors to prevent platelet aggregation.

Question 13

How does unfractionated heparin work?

Answer 13

Activates antithrombin to inhibit thrombin and Factor Xa.

Question 14

What is the advantage of low molecular weight heparin (LMWH)?

Answer 14

Longer half-life, selective Factor Xa inhibition, lower bleeding risk.

Question 15

How does warfarin work?

Answer 15

Inhibits vitamin K epoxide reductase, reducing activity of vitamin K-dependent clotting factors.

Question 16

What test is used to monitor warfarin?

Answer 16

International Normalised Ratio (INR).

Question 17

What is the therapeutic INR range for most indications?

Answer 17

Typically 2.0–3.0 (or 2.5–3.5 for prosthetic valves).

Question 18

What are two types of DOACs?

Answer 18

Direct thrombin inhibitors (e.g., dabigatran) and Factor Xa inhibitors (e.g., rivaroxaban, apixaban).

Question 19

What are the advantages of DOACs over warfarin?

Answer 19

Fixed dosing, no routine monitoring, fewer interactions.

Question 20

How does dabigatran work?

Answer 20

Directly inhibits thrombin (Factor IIa).

Question 21

How do rivaroxaban, apixaban, and edoxaban work?

Answer 21

Directly inhibit Factor Xa.

Question 22

Why should NSAIDs like ibuprofen be avoided in patients on anticoagulants?

Answer 22

They increase the risk of bleeding.

Question 23

What painkiller is preferred in patients on anticoagulants?

Answer 23

Paracetamol.

Question 24

Which antibiotic significantly interacts with warfarin?

Answer 24

Metronidazole.

Question 25

Should warfarin be stopped for routine dental procedures?

Answer 25

No, current guidelines recommend continuing it.

Question 26

Can DOACs be paused before dental treatment?

Answer 26

Yes, often a single dose is missed depending on drug and timing of procedure.

Question 27

A patient on warfarin has an INR of 4.0. What should you do before a dental extraction?

Answer 27

Defer treatment and refer to GP for INR management; risk of bleeding is elevated.

Question 28

A patient on rivaroxaban is scheduled for a morning extraction. What’s the recommended action?

Answer 28

Skip the morning dose and proceed with local haemostatic measures.

Question 29

Why is LMWH preferred in pregnancy over warfarin?

Answer 29

Warfarin is teratogenic; LMWH does not cross the placenta and is safer.

Question 30

What is the difference in onset between warfarin and DOACs?

Answer 30

Warfarin has a delayed onset (days), while DOACs act within hours.

Question 31

Which anticoagulant requires regular monitoring—DOACs or warfarin?

Answer 31

Warfarin requires INR monitoring; DOACs do not.

Question 32

What is the antidote for warfarin overdose?

Answer 32

Vitamin K.

Question 33

What is the antidote for dabigatran?

Answer 33

Idarucizumab.

Question 34

What is the antidote for factor Xa inhibitors?

Answer 34

Andexanet alfa (used for rivaroxaban/apixaban).

Question 35

Mnemonic: What is a quick way to remember DOAC types?

Answer 35

'-xaban' = Factor Xa inhibitor, '-gatran' = thrombin inhibitor.

Question 36

Mnemonic: Which factors are vitamin K-dependent?

Answer 36

1972 CSZ (Factors X, IX, VII, II + Proteins C, S, Z).