Anticoagulants, Thrombolytics, Antiplatelet Therapies Flashcards
What are the 3 phases of coagulation
- Initiation
- Amplification
- Propagation
Anticoagulants
- Heparin
- Direct thrombin inhibitors
- Direct factor Xa inhibitors
- Warfarin
- DOAC
Antiplatelet
- Aspirin
- ADP inhibitors (Clopidogrel)
- Glycoprotein IIb/IIIa inhibitors
Which factors does Warfarin affect?
“1972”
2, 7, 9, 10
Which components does heparin affect?
2, 10
When should you put someone with a DVT or PE on aspirin?
- if they’ve had a DVT/PE
- No contraindication
In a patient who has had their first DVT episode, how long should they be anticoagulated for?
3 months
Heparin or Warfarin or LMWH
Parenteral anticoagulation is given….
BEFORE: dabigatran, edoxaban
NOT GIVEN: rivaroxaban, apixaban
OVERLAP: Warfarin
How is heparin dose calculated?
actual body weight
How is heparin monitored?
activated partial thromboplastin time (aPTT)
How is heparin reversed?
protamine sulfate IV
Thrombocytopenia
<100,000/uL platelet count
-more common with unfractionated heparin than LMWH
What is the principle difference in pharmacologic activity between LMWH and UFH?
relative inhibition of factor Xa and thrombin
LMWH: advantages over UFH
- more predictable dose response
- clearance doesn’t depend on dose
- less chance of thrombocytopenia
- less need for monitoring
- ->SAFER for extended administration
How is LMWH (Enoxaparin) dose determined?
weight based
If patient has pork allergy they can’t take heparin or LMWH. What should you put them on?
Fondaparinux
Monitoring: LMWH versus Warfarin
LMWH: aPTT
Warfarin: Prothrombin time (INR)
What is important to remember about starting Warfarin treatment?
when first initiated there is thrombosis due to protein C deficiency
Which Factor is affected first with Warfarin initiation?
Factor 7
order: 7, 9, 10, 2
Do DOACs have a reversal agent?
no
Which DOAC is a prodrug, targets thrombin, and needs to be adjusted if the patient has renal impairment?
Dabigatran
Which DOAC is most bioavailable ?
Rivaroxaban (xarelto)
Which DOACs work on factor Xa
Rivaroxaban
Apixaban
Edoxaban
Which DOAC is taken QD and must be taken with food?
Rivaroxaban (Xarelto)
