ANTICOAGULANTS Flashcards
Which drugs are LMWHs?
enoxaparin, dalteparin, tinzaparin fondaprinux
How do LMWH work?
Enhance antithrombin activity - block clotting factors 2a and 10a and disrupt the clotting cascade
ADRs of LMWH
- haemorrhage
- bruising
- hyperkalaemia (inhibits aldosterone secretion)
When are LMWH used?
- Primary prevention of VTE
- Rx alongside warfarin to treat VTE
- in ACS alongside an antiplt (clopidogrel) to maintain vascularisation
Interactions of LMWH
Synergistic effect with other antiplts and anticoagulants
Who should they be used with caution in?
- uncontrolled hypertension
- STOP before surgery
Renal impairment and LMWH
LMWH and fondaparinux accumulate in renal impairment - use unfractionated heparin instead
What information should be given to patients RE LMWH?
They have a greater risk of bleeding, so to avoid contact sports/activities that may increase their risk of bleeding
LMWH and warfarin
LMWH = used as a bridging anticoagulant at the tart of warfarin therapy until INR is within normal range
Warfarin initially has a procoagulatory effect
LMWH contraindications
Active bleeding
Recent surgery
Peptic ulcers
Thrombocytopenia
What type of drug is dabigatran?
Direct thrombin inhibitor
Indications for warfarin use
- VTE (use with heparin initially)
2. Prevention of embolism in AF and prosthetic heart valves
How does warfarin work?
Inhibits synthesis of Vit K dependent clotting factors (2, 7, 9, 10)
ADRs of warfarin
Bleeding (esp. following minor injury/from ulcers)
Spontaneous bleeding - epistaxis, retroperitoneal haemorrhage
Contraindications of warfarin
Hepatic impairment/liver disease
Pregnancy
Pts at immediate risk of haemorrhage - e.g. trauma/surgery
