Antiplatelts And Anticoagulants

Question 1

What is a DOAC

Answer 1

Direct oral anticoagulant
Eg Apixiban, rivaroxiban

Factor Xa inhibitor

Question 2

What is Warfarin?

Answer 2

Anticoagulant
Vitamin K antagonist (clotting factor) - inhibits the synthesis of clothing factors 2, 7, 9 and 10.

Given to pt who have had stroke, pros valves, AF

Heavily bound to plasma proteins so many drug interactions

Question 3

What is aspirin?

Answer 3

Antiplatelet drug
Alters throjmboxan A2 and prostacyclin balance

Given to pt who have had MI/ angina (anti-inflammatory)

Contraindications- PPI and NSAIDs

Question 4

How is a patient on warfarin managed?

Answer 4

Check INR 72 hours/ 24 hours prior to tx
Can treat if below 4

Limit and stage treatment, local haemostatic agents, suture and pack.

Question 5

How is a patient on apixiban managed?

Answer 5

For high risk procedures, miss morning dose.

Question 6

How is a patient on rivaroxiban managed?

Answer 6

For high risk procedures, delay morning dose until 4 hours after heamostasis has been achieved.

Question 7

How should patients with high bleeding risk be managed?

Answer 7

Treat early in the morning, early in week
Give emergency contact details

Question 8

How should a patient on aspirin be managed?

Answer 8

Treat without interrupting medication
- stage and limit initial treatment
- local haemostatic agents

Question 9

How does liver disease affect bleeding risk?

Answer 9

Clotting factors may be affected (produced in liver)