Anticoagulants Flashcards
What are the names of some common oral anticoagulants?
Warfarin (Coumadin; Jantoven)
Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
What are the names of some common injectable anticoagulants?
Enoxaparin (Lovenox)
Fondaparinux (Arixtra)
Dalteparin (Fragmin)
Heparin
What is the starting dose of Warfarin (Coumadin; Jantoven)?
5mg/day
Adverse effects of Warfarin (Coumadin; Jantoven):
Skin necrosis
“Purple toe” syndrome
Hemorrhage
Drug interactions of Warfarin (Coumadin; Jantoven):
Amiodarine Bactrim Protease inhibitors Phenytoin Barbiturates Fluconazole Oral contraceptives *NSAIDs also have a synergistic effect with Coumadin*
Special considerations for Warfarin (Coumadin; Jantoven):
Requires therapeutic monitoring
Dietary vit K intake must be consistent
Beverages that increase the risk of bleeding: alcohol; cranberry juice
Why should vitamin K intake be kept consistent when on Warfarin?
Changes in diet can affect its efficacy
What are some examples of foods with vitamin K that should be either avoided or kept consistent in the diet if taking Warfarin?
Spinach Green tea Asparagus Kale Brussels sprouts Collard greens Broccoli Cabbage Okra
Warfarin laboratory monitoring –> INR therapeutic range:
2.0-3.0
Mitral valve replacement: 2.5-3.5
Once stable, how often should INR be monitored when a patient is on Warfarin?
Up to every 12 weeks
What is the antithesis of Dabigatran (Pradaxa)?
A vitamin K supplement to stop bleeding
What is a disadvantage of Dabigatran (Pradaxa)?
Fewer reversal agents
Indication for Dabigatran (Pradaxa)?
ONLY for non-valvular a-fib
Dabigatran (Pradaxa) - dose:
150mg 2x/day
75mg 2x/day of renal impairment
Side effects - Dabigatran (Pradaxa):
Stomach bleeding
Increased bleeding
Is therapeutic monitoring required when a patient is taking Dabigatran (Pradaxa)?
No - patients do not need to get their levels checked as often
How are drug interactions for Dabigatran (Pradaxa) compared to Warfarin?
Fewer
Dabigatran (Pradaxa) - special considerations:
New antidote: idarucizumab
No dietary considerations
What is Rivaroxaban (Xarelto) used for?
Non-valvular a-fib, used in patients who can not take Warfarin or Dabigatran
What is Apixaban (Eliquis) used for?
Non-valvular a-fib
What are pros of new oral anticoagulants?
Do not require routine monitoring
Do not have dietary considerations like Warfarin
What are cons of new oral anticoagulants?
Lack of clinical experience
Expensive
Many do not have antidote/reversal agents to stop bleeding
