Anticoagulation Flashcards
Which anticoagulants are indicated for stroke prevention?
Rivaroxaban, Apixaban and Dabigatran
What is the MOA of rivaroxaban?
It is a factor X inhibitor which targets free and clot-bound factor X which stops the activation of Factor II which in turn stops the conversion of fibrinogen to fibrin.
What is the MOA of dabigatran?
It is a factor II inhibitor which inhibits the conversion of fibrinogen to fibrin.
Describe the regimen of warfarin for AF
This is ually a long term treatment where the regimen begins on day 1 with 5-10mg, with subsequent doses thereafter given depending on the INR. The INR can be measured on subsequent days until the INR is between 2-3. They should be measured twice a week for 1-2 weeks, and if the INR is in range for atleast 2 measurements, then the INR can be measured once weekly. After this, depending on the patient’s INR stability, it can be measured every 12 weeks.
Patients with certain conditions should be monitored more often. Which conditions would these be?
Patients with an increased risk of overcoagualtion, severe hypertension, renal failure and liver disease
Can warfarin and aspirin be taken together?
Yes they can, but high dose aspirin should be avoided as it can increase the bleeding risk. Monitor patients for bleeding if they are taking low dose aspirin together with warfarin.
What treatment can be given for patients with a pulmonary embolism?
For haemodynamically stable patients with pulmonary embolism should be given a LMWH (enoxaparin or dalteparin) or fondaparinux. Patients with renal impairment or an increased risk of bleeding should be given unfractionated heparin. Other people can be given rivaroxaban or warfarin.
How would a patient be initiated on warfarin for pulmonary embolism?
Heparin is administered concomitantly with warfarin to provide immediate anticoagulation, as it takes several days for warfarin to take effect, even with a loading dose. It takes 48 to 72 hours for the anticoagulant effect of warfarin to fully develop.
