Anticoagulants

Question 1

aspirin

Answer 1

decreases thrombus risk in CAD and post- MI patients

inhibits COX/PLT aggregation

SE:asthma

Question 2

thienopyridines

clopidogrel (Plavix)
ticlopidine (Ticlid)

Answer 2

these drugs block ADP receptors on platelets, to inhibit platelet aggregation

Role:

• aspirin intolerance
• history of MI or stroke
• PVD
• post-vascular intervention

Complications:
GI bleed
hemorrhage

Question 3

Glycoprotein IIB/IIIa inhibitors

abciximab
tirofiban
eptifibatide

Answer 3

mechanism: inhibit platelet aggregation by binding to GPIIb/IIIa receptor

Role:

• unstable angina
• following coronary vessel intervention
• non-STEMI, in patients who are being managed medically

complications: hemorrhage

Question 4

Adenosine re-uptake inhibitors

Dipyridamole (Aggrenox)

Answer 4

Role:
recent stroke
artificial heart valve replacement (with warfarin), but this is second line usually clopidogrel is used instead

Adverse effects:
HA

Question 5

Heparin

Answer 5

Makes antithrombin more active
antithrombin inactivates thrombin and other coagulation factors, shutting down the body’s ability to make more fibrin clots

Role: 
post-op DVT prophylaxis
dialysis (heparin flush)
flush IV catheter
decreases post- MI thrombus risk
safer than warfarin during pregnancy

monitor with PTT

Side effect:
thrombocytopenia, heparin- induced
a state of hypercoagulability despite thrombocytopenia (low platelets)
In HIT, antibodies form that end up aggregating activated platelets and taking them out of circulation.

Question 6

Low molecular weight heparins

enoxaparin
dalteparin

Answer 6

bind to factor Xa
prevent clot formation
used like heparin, but easier to administer because given sQ 2x qD instead of continuously, with weight-based dosing

can monitor with anti-factor Xa

Safest during preg

do not require monitoring with PTT

Question 7

Direct thrombin inhibitors

argatroban
bivalidurin

Answer 7

role: anticoagulation in HIT

Fondaparinux acts by activating thrombin, and it can also be used to treat HIT (indirect thrombin inhibitor)

Question 8

Direct factor Xa inhibitors
Riveroxaban
Apixiban

Answer 8

can be given orally

role: afib
post-op DVT prophylaxis

Direct thrombin inhibitors

Question 9

Warfarin

Answer 9

inhibits Vit K dependent activation of factors 10,9,7,2,protein S, protein C

role:
hypercoagulable syndromes
atrial fibrillation
artificial heart valves
DVT/PE

adverse effects:
hemorrhage
drug interactions
teratogeniic

monitor with PT/INR

manage OD
vitamin K (2-3 days), FFP

bridge with heparin

Question 10

Streptokinase mechanism

Answer 10

cleaves fibrin clots

Question 11

What anticoagulants are safe in pregnancy?

Answer 11

LMWH

unfractionated heparin