Anticoagulation Overview + Drugs (Brand/Generic)

Question 1

MOA: Inhibits factors 2, 7, 9 and 10

Answer 1

Warfarin

Question 2

MOA: Inhibits factor Xa (directly)

Answer 2

rivaroXaban
apiXaban
edoXaban

“DOACs”

Question 3

MOA: Inhibits thrombin directly

Answer 3

IV - argatroban & bivalirudin

PO - dabigatran

Question 4

MOA: Indirectly inhibits factor Xa

Answer 4

fondaparinux

Question 5

MOA: has equal anti-Xa and anti-IIa activity

Answer 5

UFH

Question 6

MOA: has more anti-Xa activity than anti-IIa

Answer 6

LMWH - enoxaparin & dalteparin

Question 7

Anticoagulants are used in what conditions?

Answer 7

ACS, DVT/PE, and VTE

Question 8

DOAC vs Warfarin

Answer 8

1) DOACs has less DDIs and shorter half-life
2) Dosing based on kidney/liver function not INR
3) DOACs preferred for stroke prophylaxis in AFib
3a) if pt has mechanical heart valve or mitral stenosis - use Warfarin
4) Use DOACs for VTE treatment
4a) cancer - use LMWH
4b) if pt has anti-phospholipid syndrome - use Warfarin

Question 9

Heparin-induced thrombocytopenia (HIT) develops in hospital setting, what anticoag is the drug of choice?

Answer 9

IV - argatroban

PO - dabigatran (Pradaxa)

Question 10

UFH VTE Prophylaxis dose

Answer 10

5000 units SC Q8-12H

Question 11

UFH VTE Treatment dose

Answer 11

80 units/kg IV bolus; 18 units/kg/hr infusion

Question 12

UFH ACS/STEMI Treatment dose

Answer 12

60 units/kg IV bolus; 12 units/kg/hr infusion

Question 13

What weight is used to calculate UFH & LMWH for dosing?

Answer 13

total body weight (TBW)

Question 14

Labs monitored on UFH

Answer 14

1) aPTT or anti-Xa level - Q6h (NR: 1.5-2.5 x control)
2) Plts
3) Hgb
4) Hct

Question 15

UFH reversal agent “antidote”

Answer 15

Protamine

Question 16

LMWH VTE Prophylaxis dose

Answer 16

30 mg SC Q12H or 40 mg SC daily

-CrCl <30 mL/min - 30 mg SC daily

Question 17

Labs monitored on LMWH

Answer 17

Plt, Hgb, Hct, SCr

anti-Xa recommended in pregnancy
*peak anti-Xa levels 4 hours post SC dose