Anticoagulants Flashcards
MOA of unfractionated heparin (UFH)?
Binds ATIII causing inactivation of factor IIa and Xa
MOA of low molecular weight heparin(LMWH)?
Binds ATIII causing inactivation of factor Xa
MOA of warfarin?
Inhibit sliver synthesis of vitamin K dependent factors (II, VII, IX, X)
MOA of dibigatran?
Direct thrombin (IIa) inhibitor
MOA of rivaroxaban and apixaban?
Direct factor Xa inhibitor
Onset of action of UFH?
rapid
Onset of action of LMWH?
3-5 hours
Onset of action of warfarin?
hours-days
Onset of action of dabigatran?
peak 1-2 hours
2-3 days to steady state
Onset of action of rivaroxaban and apixaban?
peak action 2.5-4 hours
Elimination route of UFH?
Cleared by reticuloendothelial system
Elimination route of LMWH?
Renal clearance (decrease dose in renal failure)
Elimination route of warfarin?
Hepatic metabolism, CYP2C9
Elimination route of dabigatran?
Primary renal (remember to renal dose)
Elimination route for rivaroxaban and apixaban?
Hepatic CYP3A
Monitoring lab test for UFH?
aPTT
anti-factor Xa prn
Monitoring lab test for LMWH?
not needed
anti-factor Xa prn
Monitoring lab test for warfarin?
PT (INR)
Monitoring for dabigatran, rivaroxaban, and apixaban?
No routine monitoring
Adverse effects of UFH?
Bleeding, thrombocytopenia
Adverse effects of LMWH?
Bleeding, thrombocytopenia
Adverse effects of warfarin?
Bleeding, skin necrosis
Adverse effects of dabigatran?
Bleeding, gastritis symptoms
Adverse effects of rivaroxaban and apixaban?
Bleeding
What two anticoagulants are safe in pregnancy?
UFH and LMWH
DDIs with all anticoagulants?
NSAIDs - they increase bleeding risk
DDIs with UFH and LMWH?
Antiplatelet agents.
DDIs with warfarin?
CYP450 inhibitors
CYP450 inducers
Dietary vit K
DDIs with Dabigatran, rivaroxaban, and apixaban?
P glycoprotein inducers (rifampin, dronedarone) decrease effect
P glycoprotein inhibitors increase effect
CYP3A4 inhibitors effect rivaroxaban
Overdose treatment for UFH?
Protamine
Overdose treatment for LMWH?
Protamine
Overdose treatment for warfarin?
Phytonadione (Vit K1)
FFP
Overdose treatment for dabigatran?
Idarucizumab
Overdose treatment for rivaroxaban, apixaban?
Andexanet alfa (rXa)
Uses for UFH?
ACS, VTE
Uses for LMWH?
ACS, VTE
Uses for warfarin?
A-fib, VTE prophylaxis
Uses for Dabigatran?
VTE
Uses for rivaroxaban?
A fib, DVT-PE prevention after total hip or total knee
Uses for Rivaroxaban?
A fib, DVT-PE prevention after total knee or total hip
Uses for apixaban?
A fib
