anticoagulation Flashcards
what are the intrinsic pathway and which drug inhibits the intrinsic pathway
XII-XI-IX-X–> XA
warfarin blocks X
also blocks IX, VII, II
what is the extrinsic pathway
VII–>VII—–> X->Xa
warfarin blocks this too
what are the factor Xa inhibitors
Apixaban
rivaroxaban
edoxaban
UFH and LMWH also block XA and IIa
fondaparinux
which factor is thrombin and what meds can block thrombin
factor IIa is thrombin
Direct thrombin inhibitors are
PO- Dabigatran
IV- Argatroban bivalirudin
UFH and LMWH also block XA and IIa
Warfarin blocks prothrombin
DOACS are preffered in
stroke prophylaxis in AFIB
** if mitral stenosis or mechanical heart valve use warfarin
VTE
** cancer use LMWH
antiphospholipid syndrome use warfarin
what are some bleeding symptoms
nose bleed or epistaxis
gums
bruising
blood in vomit
blood in feces
uti
MOA of heparin
antitrombin binding which blocks IIa activation
- short half life
- can cause HIT, hyperkalemia and osteoporosis
monitor APTT antiXa level
antidote Protamine
what is the heparin dose for prophylaxis VTE
5000 q8-12
what is the treatment dose for VTE for heparin
80u/kg/ IV + 18u/kg/hr
treatment dose for ACS with heparin
60u/kg bolus+ 12 u/kg/hr
what is the treatment dose for prophylaxis VTE with enoxaparin
30mgSC Q12 or 40mg SC daily
<30 CRcl = 30
what is the treatment dose for VTE and NSTEMI with enoxaparin
1mg/kg q12 or 1.5mg/kg daily
<30 CrCL 1mg/kg SC daily
TBW
what is the treatment dose for STEMI
<75 years 30mg IV bolus + 1mg/kg SC q12
CRCL <30 30mg IV + 1mg SC Qdaily
>75years 0.75mg/kg SC q12
CRCL <30 1mg/kg SC daily
LMWH MOA
same as heparin + XA inhibition
cant use in HIT, monitor anti XA not APTT
protamine is the antidote
HIT
unexplained drop of plt by 50% after 5-14 days of heparin used
Bivalidurin is preffered in HIT
no warfarin use until ptl is >150k
DOAC
apixaban eliquis
rivaroxaban xarelto
dabigatraan pradaxa
argatroban
bivalirudin angiomax
what is the dose for treating DVT with apixaban or eliquis
10mg PO BID for 7 days
then 5mg BID
what is the dose for treating prophylaxis DVT with apixaban or eliquis
2.5mg BID for 12 days if knee
ofr 35 days if hips sx
1st dose after 12-24 hours of sx
andexa andexanet alfa for antidote
what is the dose for treating afib with apixaban or eliquis
5mg BID unless
age is >80, BW <60kg SCR >1.5
any of the aboce 2 then dose is 2.5 mg BID
what is the dose for treating afib with rivaroxaban or xarelto
** any dose above 15 should be taken with food
CRcl >50 20mg daily with food
CRCL 15-50 15mg
crcl <15 avoid
what is the dose for treating DVT with rivaroxaban or xarelto
15mg BID for 21 days the n 20mg daily
CRCL <30 avoid
what is the dose for treating prophylaxis DVT
10mg daily for 12 days or 35 days
CRCL<30 avoid
what is the dose for treating Afib with Dabigatran or pradaxa
150mg BID
CRCL 15-30 75mg BID
<15 avoid
antidote- idarucizumab (praxbind)
what is the dose for treating DVT with dabigatran
150mg BID 5-10 days after IV anticoags
avoid CRCL<30
which doacs used for HIT
argatrroban and bivalirudin
how does bridging works with warfarin to doac
warfarin to rivaroxaban, edoxaban, apixaban, dabigatran
INR is <3,2.5,2,2
READ
how does bridging work from doacs to warfarin
overlap until INR is therapeutic
for dabigatran start 1-3 days before stopping dabigatran
what is the starting dose for warfarin
10mg daily for 2 days then with INR change doses
Please Let Greg Brown Bring Peaches To Your Wedding
1 2 2.5 3 4 5 6 7.5 10
what are some drug interactions of warfarin
CYP2C9 sybstrate
CYP2C9 inhibitors- amiodarone, fluconazole , bactrim metronidazole
CYP2C9 inducers- rifampin, carbamazepine, phenytoin
what does the CHA2DS2VAS score
chf
HTN
AGE >75
Diabetes
Stroke TIA
Vascular disease
Age 65-74
SEX female
when is oral anticoag recommended with CHA2DS2VAS
male 0 no
male 1 maybe
male 2 must NON warfarin DOAC
Female 1 no
F 2 maybe
F3 must
which anticoag should not be used in CrCL >95
edoxaban
pradaxa bottle is good for
120 days
