Antiplatelet/anticoagulant therapy Flashcards
What are the anti-thrombins
Argatroban
Dabigatran
Bivalirudin
how does heparin work
1) potentiates the effect of antithrombin
2) Xa inhibition
LMWH mechanism
Mostly through Xa inhibition but also potentiates antithrombin
How is heparin dosed
- bolus
- then weight based
how quickly can you anti-coagulate someone with heparin
6-8 hours
How to monitor heparin therapy
- Xa is better than APTT (better correlates to therapeutic heparin range)
Anti-Xa inhibitor for reversal
Andexxa
First line indications for warfarin
- Mechanical heart valves
- Antiphospholipid antibody syndrome
- it is a second line anticoagulant these days otherwise.
What does INR measure
Patients PT over normal PT
When does warfarin skin necrosis occur
Within 24 h of warfarin treatment
Warfarin reversal
PCC concentrate + vitamin K
How much FFP does it take to reverse most patients with supratherapeutic INRs on warfarin
PCC concentrate (it takes less PCC than FFP to correct)
bivaluridin advantages and disadvantages
shorter half life but very expensive so we don’t use it much
what are the Xa inhibitors
apixaban
rivaroxaban
edoxaban
betrixaban
DOAC’s vs warfarin in terms of bleeding risk
- DOAC’s have significantly less risk of intracranial or fatal bleeding
Only AC that has been shown to be inferior in VTE risk in cancer patients
Warfarin
Xa reversal agent
Andexant alpha
Dabigatran reversal agent
There’s a monoclonal antibody called idarucizumab
What else can you use to reverse Xa’s?
PCC (but not FDA approved)
Clopidrogel/prasugrel class of drugs name
Thienopyridines
Reversal agent for lovenox and heparin
Protamine sulfate
what are the low-molecular-weight heparin drugs?
Dalteparin
Enoxaparin
Heparin high intensity PTT range at UMass
65-85
