Antiplatelets (HRDs), Heparin, LMWH, Tranexamic acid

Question 1

Tranexamic acid 500mg tabs POM

Answer 1

Indications
Local Fibrinolysis, Menorrhagia, Hereditary angioedema, Epistaxis (nose bleed).

Helps blood to clot and used for nose bleeds and heavy periods.

DOSE:
Fibrinolysis - 1-1.5g BD/TDS - Adult
Menorrhagia - 1g TDS for 4 days and start when periods starts MAX 4g/day - Adult
Epistaxis - 1g TDS 7 days

AEs: Diarrhoea (reduce dose), NV

Monitoring
Regular LFT in long use for Hereditary angioedema.

Question 2

Tranexamic acid P - Menorrhagia
GPHC Q

Answer 2

Tranexamic acid controls/reduces bleeding.

Adult dose: 1g TDS for 4 days
- 18 and above can buy.
- Take WITH/Without food.

Increased risk of DVT with contraceptive pill (EXAM Q)

Contraindication
Epilepsy, DVT, PE, Irregular periods, renal issues, pregnancy.

RED FLAGs
Colour vison change or visual impairment - STOP drug

Signs of DVT/PE. (DVT - Swollen, red & warm to touch legs, PE - SOB, Sharp pain in the chest).

Coughing blood/ Coughing

Anaphylactic reactions.

Question 3

Parenteral Anticoagulants

Answer 3

HEPARIN:
- Fast acting but short duration
- Known as standard or Heparin to separate them from LMWH.
- LMWH preferred for routine use BUT UFH can be used in those with high risk of bleeding BC AEs are terminated rapidly due to short duration
- SAFE in pregnancy

LMWH:
Dalteparin, enoxaparin, tinzaparin
- Used in Prophylaxis/Treatment of DVT, PE & MI.
- Preferred over heparin - BC they effective and have reduced risk of Heparin induced thrombocytopenia (HIT)
- Duration longer than heparin and is OD SC = more convenient.
- Dalteparin and Tinzaparin licensed for extra treatment/prophylaxis in VT with solid tumours. (20k only)

Question 4

Antiplatelet

Answer 4

Aspirin, clopidogrel, dipyridamole (3 most common), prasugrel, ticagrelor
Glycoprotein IIb/IIIa inhibitors: abciximab (moa), tirofiban, eptifibatide.
- Decrease platelet aggregation so inhibit thrombus formation in arterial circulation.

Aspirin now only FOR SECONDARY prevention. No longer primary - has no benefit.
- Give PPI if PTs at high risk of bleeding.
- Aspirin + Clopidogrel increases bleeding risk.

CLOPIDOGREL:
- Prevention of atherothrombotic event (ACS, IS)

DYPYRIDAMOLE:
- Prophylaxis if thromboembolism with prosthetic heart valves.
- MR preps used for 2ndry prevention of IS/TIA (200mgBD +food)
IMPORTANT PRESCRIBING INFO:
- MR caps need to be given in OG container any extra caps should be discarded 6 weeks after opening.