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Cardiovascular > anticoagulants > Flashcards

anticoagulants Flashcards

1
Q

what are the benefits of warfarin?

A

can save a life from thrombo-embolism
AF patients have 60% reduction in strokes

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2
Q

what are the negatives in using anticoagulants?

A
  • Frequent to causing preventable harm and admissions to hospitals
  • Major cause of bleeding
  • Major litigation (use or not use)
  • Dose adjustments frequently required to avoid over or under anticoagulation
  • rapid fall in protein C and S in first 2-3 days - increased risk of thrombosis on this time
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3
Q

what is the mode of action of warfarin?

A

prevents vit K promoted carboxylation of glutamic acid residues of factors I, VII, IX and X
prevents vit K dependent clotting factors
full anticoagulated in 48-72hrs

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4
Q

what do protein C and S do?

A

prevent blood clotting too much

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5
Q

what is INR?

A

internalised normalised range/ ratio
- standardised to reduce variation
based on patients on variation
- way to measure patients warfarin levels

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6
Q

what is contra-indicated with warfarin?

A
  • Avoid 48hrs post partrum
  • Haemorrhagic stroke
  • Significant bleeding
  • Known coagulation defects
  • Excessive alcohol intake
  • Prone to falls
  • Endocarditis
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7
Q

which group are high risk with warfarin?

A

pregnant women, elderly, end-stage renal disease, poor drug/ clinic compliance, CVS disease

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8
Q

what needs to be measured prior to starting warfarin?

A
  • Prothrombin time – normal time for clotting
  • Activated partial thromboplastin time (APTT) – time taken to clot with specific agents added
  • Platelet count
  • FBC
  • Liver function test
  • Baseline INR – should be 1
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9
Q

how many mg within the brown warfarin pill?

A

1mg

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10
Q

how many mg within the blue warfarin pill?

A

3mg

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11
Q

how many mg within the red warfarin?

A

5mg

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12
Q

what are the indications to warfarin?

A
  • Prophylaxis of embolism in rheumatic HD +AF
  • Prophylaxis after insertion of prosthetic heart valve
  • Prophylaxis and treatment of venous thrombosis and PE
  • TIA
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13
Q

what are side effects of warfarin?

A

bleeding, hypersensitivity, skin rashes, alopecia, diarrhoea, unexplained drop in haemocrit, jaundice, hepatic dsyfunction, purple toes, skin necrosis

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14
Q

what is the warfarin antedote?

A

vitamin K - phytomeandione
- stop taking warfarin may be more beneficial?

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15
Q

how many days prior to surgery would you stop taking warfarin?

A

5 days

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16
Q

if a patient requires antocoag before surgery, what would you do?

A

bridging - using LMWH as that can be used until 2hrs prior to surgery

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17
Q

what interacts with warfarin?

A

refer to BNF
alcohol
anything that increases bleeding risk - caution
oral contraceptive
st johns wort
cranberry/ grapefruit juice
other antiplatelets - use with caution

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18
Q

what is unfractionated heparin?

A

high molecular weight molecules, highly ionised

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19
Q

how must unfractionated heparin be administered?

A

not absorbed in GI
must be IV/ SC injection - gives high monitoring

20
Q

which patients would benefit from unfractionated heparin the most?

A

high risk patients/ renal impairment - more in control and enough evidence

21
Q

what do you monitor with a patient on unfractionated heparin?

A

trust protocol
prothrombin time, activated partial thromboplastin time
platelet count - HIT
FBC, liver function test
potassium

22
Q

what is activated partial thromboplastin time?

A

time takes to clot with another agent present

23
Q

what is HIT - platelet count

A

heparin induced thrombocytopenia - contra indicated with heparin
<80 need haematology referral

24
Q

what is the antedote of unfrationated heparin?

A

protamine

25
Q

what is the benefit of LMWH over warfain?

A

more predictable response

26
Q

what is the action of LMWH?

A

indirect thrombin inhibitors
- enhance antothrombin II - inhibits thrombin IIa
- inactive factor Xa

27
Q

how do you administer LMWH?

A

SC injection, dosage based on weight

28
Q

what are the advantages of using LMWH over warfarin?

A

fixed dose, no labs, highly predictable plasma levels, higher bioavailability, ,longer half life - taken OD/ BD

29
Q

what are the disadvantages of LMWH over warfarin?

A

more expensive

30
Q

when would LMWH be best to use?

A

PE, DVT, thromboprophylaxis, daltaparin, tinzaparin

31
Q

what is contra-indicated with LMWH?

A

all heparins, endocarditis, major trauma, epidural, avoid benzyl injections, peptic ulcer, thrombocytopenia

32
Q

what is the antedote of LMWH?

A

can only be partially reversed
protamine

33
Q

what are DOACs?

A

direct oral anticoagulants

34
Q

name some DOACs?

A

dabigatran, rivaroxaban, apixaban, edoxaban

35
Q

when are DOACs used?

A

non-valvular AF, DVT, PE - treatment and prophylaxis of current VTE

36
Q

rivaroxaban also has other uses other DOACs do not, what are they?

A

prophylaxis of atheromatic events following ACS with elevated cardiac biomarkers
- can be taken with/ without aspirin

37
Q

what is the action of DOACs?

A

prevents prothrombin to thrombin pathway
acts on Xa factor

38
Q

what are the benefits of DOACs?

A

no INR monitoring, predictable anticoag reponse, rapid onset (1-4hrs), lower risk of bleeding, including intracranial.
stroke protection equivalent to warfarin
- can go in compliance aids (dosage boxes), can be crushed

39
Q

what is the new first line anticoagulant?

A

DOACs

40
Q

what is contra -indicated with DOACs?

A

lesion/ condition that can increase bleeding risk significantly
- current/ recent GI ulcer
presence of malignant neoplasm
recent brain/ spinal surgery, intercranial haemorrhage
vascular aneurysms/ major intraspinal abnormalities
WITH ANY OTHER ANTICOAGULANTS

41
Q

what needs to be checked prior to starting DOACs?

A

check interactions
age, weight
renal function

42
Q

what should rivaroxaban be taken with?

A

food - increases bioavailability

43
Q

what are side effects of DOACs?

A

GI disturbances, pain, dsypesia, altered liver function, rash/ pruritis, epitaxis, bruising, small haemorrhages

44
Q

what side effects are common to rivaroxaban?

A

dizziness, may affect ability to drive, tachycardia, dry cough

45
Q

what does CHA2DS2-VASc do?

A

assess stroke risk following AF

46
Q

what is HAS-BLED used for?

A

bleeding risk score system on anticoagulants

47
Q

what is ORBIT?

A

bleeding risk score system for those who had AF
- used more commonly in practice

Cardiovascular (14 decks)

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