Anticoagulants Flashcards
Unfractionated heparin MoA
Forms complex with AT III
ATIII and thrombin complex both individually bind to heparin, and inhibit factor IIa (thrombin)
only AT III required to bind to Xa (not heparin)
LMWH examples
Dalteparin, Enoxaparin
LMWH MoA
Inhibits factor Xa by enhancing AT III activity
Differences in dose response between UFH and LMWH
LMWH dose is predictable as it doesnt bind to endothelial cells etc
UFH use
Moderate renal impairement
LMWH use
prophylaxis of thromboemobolism
pregnancy- does not cross placenta
ACS
Monitoring of heparin
LMWH- little monitoring
aPPT required for UFH
Heparin reversal agent
Protamine sulphate
Heparin ADR
Bleeding
heparin induced thrombocytoenia
hyperkalaemia (aldosterone inhibited)
Osteoporosis
Heparin DDI
ACE inhibitors, Amiloride (diuretic), spironolactone (causing hyperkalaemia)
Warfarin MoA
Inhibits Vitamin K epoxide reductase- inhibits reduction of vit K into active form
Inhibits activation of Vit K dependent clotting factors- 2,7,9 10
Warfarin uses- oral
Severe renal impairement
Venous thromboemobilism
Atrial fibrillation
Warfarin in pregnancy
contra-indicated - crosses placenta
teratogenic in 1st semester
haemorrhagic in 3rd semester
Warfarin DDIs
CYP2C9 polymorphisms
Antibiotics reduce GI vit K - increase INR
NSAIDs decrese GI vit K absorption - increase INR
CYP inducers accelerate Warfarin metabolsim - decrease INR
Metronidazole inhibits CYP2C9- increase INR
Warfarin monitoring
Prothrombin time- Factor VII most sensitive to vit K deficiency
Use INR to compare