Anticoagulation drugs

Question 1

Anticoagulation drugs

Answer 1

Stop coagulation: 
Incl Heparin (fast)
Enoxaparin
Argatroban
Fondaparinux
Warfarin (slow)
Rivaroxaban
Apixaban

Question 2

Antiplatelet drugs

Answer 2

Stop formation of platelet plug:
Incl Asprin
Clopidogrel
Ticagrelor

Question 3

Thrombolytic drugs

Answer 3

Lyse clots
Tiny dose, “cath flow”
Big dose, true “clot busters” for ISCHEMIC stroke (not hemorrhagic stroke)
Incl Alteplase - TPA

Question 4

Heparin

Answer 4

Anticoag drug - fast
SC as prophylaxis in hosp
IV as therapeutic tx
Indirectly inhibits clotting factors 2 and 10
Lab used: PTT
Reversal agent: Protamine Sulfate
AE: HIT (heparin-induced thrombocytopenia)

Question 5

Enoxaparin

Answer 5

Anticoag drug - type of heparin
SC only
Selectively inhibits clotting factor 10
Monitoring not required 
AE: HIT 
Boxed warning: spinal/epidural hematoma

Question 6

Argatroban

Answer 6

Anticoag drug - non-heparin injectable
For pts who can’t use heparin bc of HIT
Direct thrombin inhibitor

Question 7

Fondaparinux

Answer 7

Anticoag drug - non-heparin injectable
For pts who can’t use heparin bc of HIT
Clotting factor 10 inhibitor
Boxed warning: spinal/epidural hematoma

Question 8

Warfarin

Answer 8

Anticoag drug - vit K antagonist
PO - once pt stabilized
Slow compared to heparin
Inhibits clotting factors 2, 7, 9, 10 and proteins C and S
Lab used: PT
INR range: 2-3, <2 high risk for clotting, >3 high risk for bleeding
Reversal agent: Vit K
FDA boxed warning: bleeding, skin necrosis, Purple Toe Syndrome
Essential pt counseling points

Question 9

Essential pt counseling points for warfarin

Answer 9

Monitor INR
Be consistent in amount of vit K you eat to maintain INR (2-3) - NOT saying “don’t eat salad”
Caution w/NSAIDs, falls
Know s/sx of bleeding
Notify all health providers about tx (e.g., dentist)

Question 10

Anticoag bridge therapy

Answer 10

Begin pt on heparin and warfarin
Heparin works fast to stabilize pt
Warfarin works slow
Once warfarin INR reaches 2-3, stop heparin and just use warfarin

Question 11

NOACs

Answer 11

New oral anticoags
Incl Rivaroxaban, Apixaban
Alternative to/faster than warfarin
Clotting factor 10 inhibitor 
Monitoring not required 
Boxed warning: sudden stoppage can increase risk for thromboembolitic events, spinal/epidural hematoma

Question 12

Aspirin

Answer 12

Antiplatelet - “the original”
Irreversibly interrupts COX 1 and 2 pathways –> prevents synthesis/release of prostaglandins
Boxed warning: increased risk for GI bleeds, ulcers
Don’t take w/herbs that begin w/”g” bc increase bleeding (e.g., garlic supplements)

Question 13

P2Y12 ADP receptor antagonists

Answer 13

Antiplatelet
Incl Clopidogrel (prodrug), Ticagrelor
Block P2Y12 ADP receptors on platelets –> prevents aggregation
Ticagrelor used after coronary artery stent placed to prevent platelets from sticking to stent
AEs: dyspnea (scary for pt who just started med after an MI), TTP (thrombotic thrombocytic purpura)

Question 14

Alteplase - TPA

Answer 14

Thrombolytic
Tiny dose, “cath flow”
Big dose, true “clot buster” for ISCHEMIC stroke (not hemorrhagic stroke)
Binds to plasminogen –> plasmin digests clots
MUST be given w/in 3-4 hr of sx onset (look at clock!)
AEs: bleeding, death