anticoagulants Flashcards

1
Q

unfractionated heparin MOA

A

binds to antithrombin III

inhibition of factor II and X

small platelet inhibition

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2
Q

unfractionated heparin/LMWH antidote

A

protamine

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3
Q

heparin monitoring and normal ranges

A

PTT - 50-80 sec (1.5-3x baseline is therapeutic)

anti Xa - 0.3-0.7 U/mL

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4
Q

adverse effects of heparin

A

bleeding

skin necrosis, HIT, altered bone metabolism

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5
Q

HIT diagnosis

A

antibody tests

4 T’s score

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6
Q

HIT treatment

A

argatroban

also fondaparinux and bivalrudin but not FDA approved

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7
Q

LMWH MOA

A

binds w antithrombin to inhibit factor X

mild inhibition of factor II

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8
Q

UFH vs LMWH

A

LMWH has more predictable response, less bleeding, no routine lab monitoring, able to be given as outpatient

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9
Q

dosing adjustment for LMWH

A

renal

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10
Q

bivalrudin MOA

A

direct thrombin inhibitor

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11
Q

dosing adjustment for bivalrudin

A

renal

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12
Q

bivalrudin dosing

A

0.1 mg/kg bolus, then 0.25 mg/kg/h

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13
Q

argatroban MOA

A

direct thrombin inhibitor

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14
Q

bivalrudin/argatroban monitoring

A

PTT

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15
Q

argatroban dosing

A

1.7-2.0 mcg/kg/min

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16
Q

good anticoagulant & DOAC for renal impairment

A

argatroban

apixaban

17
Q

argatroban dosing adjustment

A

liver dysfunction

18
Q

fondaparinux MOA

A

long acting factor X inhibitor

19
Q

fondaparinux contraindication

20
Q

warfarin MOA

A

inhibits production of vitamin K dependent clotting factors II, VII, IX and X

converts inactive vitamin K to active vitamin K

inhibits protein C and S

21
Q

warfarin half life

A

60 hours

max impact is 5-7 days

may need to bridge w lovenox

22
Q

warfarin dosing

A

5-7.5 mg daily, then titrate to INR (2-3) q 5-7 days

23
Q

warfarin AEs

A

bleeding (higher w fluconazole, amio, bactrim, metronizadole)
skin necrosis, purple toe syndrome, vasculitis

24
Q

warfarin & factor x inhibitors antidote

A

vitamin K, kcentra

25
DOACs vs warfarin
DOACs more predictable, more rapid onset/offset, no routine monitoring, less risk of ICH and fatal hemorrhage DOAC more expensive warfarin indicated for mechanical valves
26
dabigatran MOA
direct thrombin inhibitor
27
rivaroxaban, apixaban, edoxaban MOA
factor Xa inhibitor
28
periop considerations for dabigatran
may need to hold dose for up to 5 days before surgery depending on CrCl
29
how long to hold factor X inhibitors before surgery
low risk procedures -24 h | high risk procedures - 48 h
30
dabigatran antidote
idarucizumab
31
anti xa inhibitors antidote
andexxa