Anticoagulant Therapy Flashcards
List four types of Anticoagulant Therapy.
Standard unfractionated heparin (UFH)
Low molecular weight heparin (LMWH); Coumadin drugs, Thrombolytic agents (clot busters)
Standard unfractionated (UFH): Mechanism of Action
Heparin by itself is NOT and anticoagulant
must complex with AT and AT is called the “heparin Co-factor”
Standard unfractionated (UFH): indication for therapy
treatment of thrombosis to precent propagation
Standard unfractionated (UFH): Administration
IV or subcutaneously (SQ)
Standard unfractionated (UFH): Monitoring
APTT: (target for therapy, prophylaxis, daily plt counts to detect HIT)
Standard unfractionated (UFH): Overdose
treat with protamine sulfate
Low molecular weight heparin (LMWH): Mechanism of Action
Increases the inhibitor effect of AT on thrombin and Xa. Mainly Xa
This is also known as Lovenox
Low molecular weight heparin (LMWH):
Low molecular weight heparin (LMWH): administration
SQ
Low molecular weight heparin (LMWH): Indication for therapy
Treatment of thrombosis to prevent propagation; not as commonly used but great for those needing to go home on heparin
Low molecular weight heparin (LMWH): Monitoring
anti-Xa heparin assay (APTT is insensitive)
Why is monitoring Low molecular weight heparin (LMWH) necessary?
For infants, children, obese or underweight patients, those with renal disease, or unexpected bleeding
which brand is most common for long term anticoagulant therapy?
Coumadin
Which brand is oldest brand name for long term anticoagulant therapy?
Warfarin
Coumadin: Mechanism of Action
Coumadin blocks the action of vitamin K which si needed for the synthesis of the vitamin K dependent factors. There fore, slowing thrombin formation
What are the Vitamin K dependent factors?
Prothrombin Group (II, VII, IX, X)
Coumadin: Administration
Oral
Coumadin: Delayed reaction or Immediate reaction?
Delayed reaction (3-5 days)
Coumadin: Indication for therapy
Treatment of thrombosis to prevent propagation; prevention of thromboembolic disease in thrombophilia, mechanical heart valves, and high risk surgery.
Coumadin: Monitoring
PT and INR
Coumadin: Overdose
Treat by giving vitamin K and FFP if major bleeding
Standard Unfractionated Heparin (UFH) has delayed or immediate reaction
Immediate reaction
List sources of Vitamin K
Diet: green leafy vegetables, fish , and liver
Normal gut flora: E.coli, B.fragilis
Three situations in which Vitamin K deficiency may occur.
Poor diet, long term antibiotic therapy, newborns
Vitamin K makes the Prothrombin factors functional by___
By adding a 2nd carboxyl group on the gamma carbon. In Vita K deficiency or in the presence of a Vita K antagonist, these factors are released from the liver without the gamma-carboxylation rendering them nonfunctional
Thrombolytic Agents (clot blusters): mechanism of action
Indiscriminately induce in vivo fibrinolysis by activating plasminogen to plasmin; not only get rid of bad clots but good clots too
Types of Thrombolytic agents
Tissue plasminogen activator (TPA), streptokinase, urokinase
Why is TPA considered the best/safest clot bluster?
because it will NOT activate circulating (free) plasminogen ..only fibrin bound
The use of Therapeutic drug TPA
Life threatening thromboses
Must be given within 4-6 hours of onset
