Antiplatelet/anticoagulant therapy

Question 1

What are the anti-thrombins

Answer 1

Argatroban
Dabigatran
Bivalirudin

Question 2

how does heparin work

Answer 2

1) potentiates the effect of antithrombin

2) Xa inhibition

Question 3

LMWH mechanism

Answer 3

Mostly through Xa inhibition but also potentiates antithrombin

Question 4

How is heparin dosed

Answer 4

• bolus

- then weight based

Question 5

how quickly can you anti-coagulate someone with heparin

Answer 5

6-8 hours

Question 6

How to monitor heparin therapy

Answer 6

• Xa is better than APTT (better correlates to therapeutic heparin range)

Question 7

Anti-Xa inhibitor for reversal

Answer 7

Andexxa

Question 8

First line indications for warfarin

Answer 8

• Mechanical heart valves
• Antiphospholipid antibody syndrome
• it is a second line anticoagulant these days otherwise.

Question 9

What does INR measure

Answer 9

Patients PT over normal PT

Question 10

When does warfarin skin necrosis occur

Answer 10

Within 24 h of warfarin treatment

Question 11

Warfarin reversal

Answer 11

PCC concentrate + vitamin K

Question 12

How much FFP does it take to reverse most patients with supratherapeutic INRs on warfarin

Answer 12

PCC concentrate (it takes less PCC than FFP to correct)

Question 13

bivaluridin advantages and disadvantages

Answer 13

shorter half life but very expensive so we don’t use it much

Question 14

what are the Xa inhibitors

Answer 14

apixaban
rivaroxaban
edoxaban
betrixaban

Question 15

DOAC’s vs warfarin in terms of bleeding risk

Answer 15

• DOAC’s have significantly less risk of intracranial or fatal bleeding

Question 16

Only AC that has been shown to be inferior in VTE risk in cancer patients

Answer 16

Warfarin

Question 17

Xa reversal agent

Answer 17

Andexant alpha

Question 18

Dabigatran reversal agent

Answer 18

There’s a monoclonal antibody called idarucizumab

Question 19

What else can you use to reverse Xa’s?

Answer 19

PCC (but not FDA approved)

Question 20

Clopidrogel/prasugrel class of drugs name

Answer 20

Thienopyridines

Question 21

Reversal agent for lovenox and heparin

Answer 21

Protamine sulfate

Question 22

what are the low-molecular-weight heparin drugs?

Answer 22

Dalteparin

Enoxaparin

Question 23

Heparin high intensity PTT range at UMass

Answer 23

65-85