Anticoagulation and antiplatelet therapy Flashcards
Supplement that can interact with DOACs
St. John’s wart
Heparin and LMWH targets in the clotting cascade
Xa and IIa (thrombin) (predominately Xa effects)
LMWH drugs
Enoxaparin
*Dalteparin
Clotting factors affected by warfarin
II, VII, IX, X
*also protein C and S
Other subcutaneous AC
Fondaparinux
Fondaparinux contraindication
CrCl <30
Heparin reversal agent
protamine sulfate
heparin SE’s
HIT
*osteoporosis (with long term LMWH usage)
*skin necrosis
LMWH reversal agent
- no great reversal agent, can use protamine sulfate
fondaparinux mechanism
Inhibits Xa alone
fondaparinux dosing schedule
once daily
Warfarin mechanism
Inhibits vitamin K epoxide reductase (VKORC1) leading to less reduced vitamin k, deactivating y-glutamyl carboxylase
Pathway responsible for drug interactions with DOACs
P glycoprotein transport system
DOAC clearance and metabolism
- renally cleared
- some hepatic metabolism
other DOAC reversal agent
4 factor PCC (off label)
Status of data for NOACS in obesity
- data suggest xarelto and eliquis adequate for VTE treatment regardless of weight/BMI
- more data for rivaroxaban than apixaban
- insufficient data for dabigatran and edoxaban for BMI >40
Status of DOACS for CKD
- Pts with CrCL <30 were excluded from trials
- caution with LMWH
- eliquis has least renal clearance
Status of DOACs and lovenox for chronic liver disease
- DOACs avoided with active, clinically significant liver disease
- retrospective studies and meta-analysis have not shown clear concerns with DOACs
- ## lovenox may be considered, especially if baseline INR over 2
