Antithrombotic agents Flashcards by Mellisa Wu

Anticoagulant agents drug of choice for prevention/treatment of _____ and prevention of _____ in patients with _____

venous thromboembolism
Cardioembolic event with atrial fibrillation
(Also can use for arterial thrombosis + antiplatelet)

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anti-platelet agents drug of choice for prevention/treatment of ___

arterial thrombosis (primary/secdonary prevention of ACS)

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Primary prevention with risk factor - give

aspirin

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primary prevention with no risk factors - give

aspirin (men>45, women>65)

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Secondary prevention with recent MI - give ___

aspirin (clopidogrel)

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Secondary prevention with ischemic stroke - give ___

aspirin +/- clopidogrel

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Unstable angina - give

aspirin

+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/fondaparinux, GPIIb/IIIa inhibitor

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NSTEMI - give ___

aspirin

+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/fondaparinux, GPIIb/IIIa inhibitor

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STEMI (aka ___) - give

acute MI
aspirin
+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/FONDAPARINUX, GPIIb/IIIa inhibitor

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Peripheral critical ischemia - give __

aspirin

+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/BIVALIRUDIN, GPIIb/IIIa inhibitor

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Atrial Fibrillation - give ___

Warfarin/Dabigatran/rivaroxaban/apixaban

Low risk = aspirin

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GP1a bind to ___

collagen

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GP1b bind to ___

GPIIb/IIIa + vWF

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GPIIb/IIIa bind to ___

fibrinogen

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aPTT = aka + ref range

activated partial thromboplastin time; 26-33 sec

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prolonged aPTT indicates defects in ____ pathway and used to monitor ___ therapy

intrinsic
Heparin
(note: aPTT not affected by LWMH)

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PT = aka + ref reange

prothrombin time/ 12-14 sec

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prolonged PT = defect in ___ pathway, used to monitor ___ therapy based on ___

extrinsic
warfarin
INF (international normalized ratio)

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Ecarin clotting time (ECT) uses ecarin derived from ___

venom of saw-scaled viper

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ECT prolonged = increasing concentration of ___ or ___ in plasma; used to monitor anticoagulant therapy with _______

hirudin/dabigatran

Direct thrombin IIa inhibitors

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Fibrinolysis central process is the activation of ____ to _____ by ___

plasminogen –> plasmin by tPA

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plasmin _________

proteolyzes fibrin/limits thrombosis

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Fibrin inhibition by _____ and _____

antithrombin III (accelerated by heparin)
Protein C (Ccofactor protein S)

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Protein C inactivates: _____ and ____

Va, VIIIa

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Unfractionated heparin binds to ____ and _____

antithrombin III and | IIa, Xa, (IX, XI, XII, XIII)

Enoxapirin is a ____

LMWH

LMWH binds to ___

Xa only (not IIa)

Fondaparinux is a ______ binds to __

pentasaccharide activator of ATIII, inactivates Xa only

Argatroban is a ___

direct thrombin IIa inhibitor

Bivalirudin is a ___

direct thrombin IIa inhibitor

Lepirudin is a ___

direct thrombin IIa inhibitor

Desirudin is a ___

direct thrombin IIa inhibitor

direct thrombin IIa inhibitor are given ____

parenterally

Heparin is given ___ (route of admin)

IV or SC

Heparin ____ placenta

does NOT cross

Most heparin (except LMWH) is cleared via

RES system/hepatic

LMWH compared to UFH

less thrombocytopenia, less variable response | slower, cannot be reversed by protamine, may adverse affect renal (UFH is not renal)

heparin is used adjunct in treatment of _____?

coronary occlusion in unstable angina/acute MI Prophylaxis/treat VTE Cerebral thrombosis (stroke) Post op

Adverse effect of heparin are typically

hemorrhage, hypersensitivity, thrombocytopenia (not fondaparinux), osteoporsis

_____ is used to reverse heparin

protamine

Heparin acts in ___ to inhibit ____

plasma | activated clotting factors

Warfarin acts in the ___ to inhibit ____

liver | synthesis of clotting factor

onset of warfarin effect is ___

delayed (3-5 days steady state)

Warfarin is metabolized by ___ which has ____

CYP2C9 | Genetic polymorphism

Warfarin can be given ___

orally (100% bioavailability)

Warfarin ____ placenta

does cross | DO NOT USE

Warfarin prophylaxis used mostly for ___ and ____

Afib | Prosthetic heart valves

Warfain can be reversed by ___

vit K | PCC/FFP (prothrombin complex concentrate/fresh frozen plasma)

Warfarin affects which factors?

2, 7, 9, 10, C, S

DDI: increase warfarin effect?

amiodarone, cimetidine, fluconazole, fluoxetine, metronidazole, rosuvastatin, aspirin, oral antibiotics

DDI: decrease warfarin effect?

Barbiturates, carbamazepine, phenytoin, rifampin, st john's worts, cholestyramine, colestipol, vit K

Dabigatran acts in ___ to inhibit ___

plasma | (directly inhibit) activity of thrombin

Dabigatran compared with warfarin

no frequent monitoring/dosage adjustment, expensive, no antidote for rapid reversal

Dabigatan is absorbed ___, eliminated by ___

as a prodrug - plasma/liver esterases | Renal excretion

Dabigatan is used in place of warfarin for patient with ___

non-valvular atrial fibrillation

Rivaroxaban/apixaban/edoxaban acts in __ to ____

plasma | directly inhibit factor Xa

Rivaroxaban/apixaban/edoxaban eliminated

hepatic and renal/ renal

apixaban dosing

BID

Rivaroxaban/apixaban/edoxaban used to prevent ___ and reducing risk of ___

DVT after hip/knee | Stroke, systemic embolism with non-vavlular a fib

Warfarin used in ___ associated with ___

afib | mechanical valve, bioprosthtic valve, prior mitral repair, mitral valve stenosis

Dabigatran dosing

BID

Warfarin is ___ ($) than NOAC (newer oral anticoagulants)

cheaper (6 vs 290$/mo)

Warfarin is (preferred/not preferred) in pt with chornic kidney disease

preferred