Anticoagulants and antiplatelets

Question 1

Main differences between unfractionated heparin and LMWH?

Answer 1

Unfractionated:
IV, short duration of action, Activates antithrombin III, inhibits thrombin, factors Xa, IXa, Xia and XIIa
Monitor with APTT
LMWH: sub cut, long action, activates anihrombin III, inhibits factor Xa, monitor with anti-factor Xa. less SE

Question 2

What is unfractionated heparin used for?

Answer 2

In situations with high risk of bleeding (short acting, can terminate)

Question 3

When is LMWH used?

Answer 3

1st line for treatment and prophylaxis of VTE and treatment of MI

Question 4

Can you reverse LMWH and unfractionated heparin?

Answer 4

Yes, PROTAMINE

but only partially reverses LMWH

Question 5

What should be done in major bleeding when a pt is on warfarin?

Answer 5

Vit K1 (phytomenadione) IV 5mg
2500U dried prothrombin complex

Question 6

What does dried prothrombin complex contain?

Answer 6

1972

X, IX, VII, II

Question 7

What fruit interacts with warfarin?

Answer 7

Cranberry juice

Question 8

How can you assess anticoagulant effect when a pt on rivoroxaban presents with haemorrhage?

Answer 8

INR and APTT are unreliable

Symptoms (eg number of coffee ground vomits) and Hb can be monitored instead

Question 9

When is vit K indicated?

Answer 9

If bleeding when on warfarin OR in severe liver disease