Antithrombotic Agents Flashcards
Venous thrombi are composed mainly of _____ and _______ with relatively few ______.
fibrin; trapped red blood cells; platelets
______ are composed mainly of fibrin and trapped red blood cells with relatively few platelets.
Venous thrombi
Arterial thrombi are composed mainly of _____ held together by small amounts of _____.
platelet aggregates; fibrin
______ are composed mainly of platelet aggregates held together by small amounts of fibrin.
Arterial thrombi
How is UA/NSTEMI treated?
Aspirin
± clopidogrel or prasugrel or ticagrelor
± UFH or LMWH or fondaparinux
± GPIIb/IIIa inhibitor
How is an Acute MI (STEMI) treated?
Aspirin
+ clopidogrel or prasugrel or ticagrelor
+ UFH or LMWH or fondaparinux
± GPIIb/IIIa inhibitor
What medications are given before PCI?
Aspirin
+ clopidogrel or prasugrel or ticagrelor
+ UFH or LMWH or bivalirudin
± GPIIb/IIIa inhibitor
How is A-fib treated?
Warfarin or dabigatran or rivaroxaban or apixaban
What does the CHA2DS2-VASc acronym stand for?
Congestive HF-Hypertension-Age ≥ 75-
Diabetes-Stroke-Vascular disease-Age 65-74-Sex (female)
How does Warfarin work?
Inhibit synthesis of Vit K-dependent clotting factors II, VII, IX, and X
How does Heparin work?
Combines with antithrombin III (ATIII) to inactivate active clotting factors (IIa, IXa, Xa, XIa, XIIa)
How do LMWHs/Fondaparinux work?
they combine with antithrombin III (ATIII) to inactivate Xa
How do Hirudin, Dabigatran work?
they directly inactivate IIa (thrombin)
Which drug directly inactivates IIa (thrombin)?
Hirudin
Dabigatran
How does Rivaroxaban work?
Directly inactivates Xa
Which drug directly inactivates Xa?
Rivaroxaban
Which drug combines with antithrombin III (ATIII) to inactivate Xa?
LMWHs
Fondaparinux
Which drug combines with antithrombin III (ATIII) to inactivate active clotting factors (IIa, IXa, Xa, XIa, XIIa)?
heparin
Which drug inhibits synthesis of Vit K-dependent clotting factors II, VII, IX, and X?
warfarin
What test is used to monitor heparin therapy?
aPTT
What is a normal aPTT value?
26-33 sec
Prolonged clotting time in the aPTT indicates a defect in?
the intrinsic pathway
What test is used to monitor warfarin therapy?
PT
The aPTT test is used to monitor ____ therapy.
heparin
The PT test is used to monitor ____ therapy.
warfarin
What is a normal PT time?
12-14 sec (but now reported using INR)
What does ECT stand for?
Ecarin Clotting Time
What is Ecarin Clotting Time (ECT) used for?
to monitor anticoagulant therapy with direct thrombin (IIa) inhibitors (hirudin and dabigatran)
Which test is used to monitor anticoagulant therapy with direct thrombin (IIa) inhibitors (hirudin and dabigatran)?
Ecarin Clotting Time (ECT)
Name 2 LMWHs.
Enoxapirin (Lovenox)
Dalteparin (Fragmin)
What are Enoxapirin (Lovenox) and Dalteparin (Fragmin)?
LMWHs
______ (side effect) is more likely with heparin than LMWH but NOT with fondaparinux.
Thrombocytopenia
Thrombocytopenia is more likely with heparin than LMWH but NOT with ______.
fondaparinux
Thrombocytopenia is more likely with _____ than _____ but NOT with fondaparinux.
heparin; LMWH
What is the heparin antidote?
protamine
Can heparin be given in pregnancy? Can warfarin?
heparin = yes
warfarin = no
What kind of drug is Dabigatran (Pradaxa)?
a newer oral anticoagulant (NOAC)
non-vitamin K antagonist
*** inhibits factor IIa (thrombin)
What kind of drugs are Rivaroxaban (Xarelto), Apixaban (Eliquis), and Edoxaban (Savaysa)?
newer oral anticoagulants (NOACs)
non-vitamin K antagonist
*** inhibit factor Xa
