Antithrombotic Meds & Anesthesia Recommendations Flashcards
Heparin class and MOA
class: anticoagulant
MOA: forms a complex with antithrombin III which increases antithrombin IIIs activity 1,000x
- inhibits thrombin IIa and factor Xa (2a and 10a)
- Depresses factors IXa, XIa, and XIIa (9a, 11a, and 12a)
Heparin use and route
Use: DVT prophylaxis, PE, acute coronary syndrome
Route: IV, SQ
Heparin dose
SQ 5,000 units for DVT prophylaxis
Heparin onset and DOA
onset = rapid
DOA = 3 - 6 hours
Heparin metabolism and elimination
metabolism: liver
elimination: heparin-protamine complexes eliminated via reticuloendothelial system
Heparin considerations
- check PTT
- risk of HIT
- bleeding risk
Protamine class and MOA
class = heparin antidote
MOA = combines with heparin to form an inactive compound without anticoagulation effects
Protamine use and route
use = reverse heparin
route = IV
Protamime Dose
based on heparin dose …
- 1mg per 100U of Heparin
- Give <5mg/min, risk of anaphylaxis
Protamine onset and DOA
Onset = 5 min
DOA = 2 hours
lasts shorter than heparin, rebound bleeding can occur
protamine metabolism and elimination
metabolized and eliminated by reticuloendothelial system
Protamine considerations
- derived from salmon semen
- anticoagulative effect
- releases histamine
- hypotension
- pulmonary HTN
- circ collapse
- facial flushing
- bronchoconstriction
Tranexamic Acid (TXA) class and MOA
Class = antifibrinolytic agent
MOA = synthetic reversible competitive inhibitor to the Lysine receptor found on plasminogen. The binding of this receptor prevents plasmin (activated form of plasminogen) from binding to and ultimately stabilizing the fibrin matrix.
TXA use and route
use = given IV to prevent or reduce bleeding and the need for transfusion
route = IV, PO
TXA Dose
1 g / 10 min
may repeat within 8 hours with MAX 2 g
TXA metabolism and elimination
Metabolism = liver (small portion)
elimination = renal (largely unchanged)
Rapid transfusion of TXA can cause ____.
hypotension
TXA contraindications
- known allergy to TXA
- intracranial bleeding
- history of venous or arterial thromboembolism or active thromboembolic disease
Aspirin type and mechanism
Type = anti platelet
Mechanism = COX 1 inhibitor (irreversible)
ASA half life
20 min
ASA reversal agent
PLTs
ASA anesthesia recs
stop 7 days
ASA lab monitoring
none
NSAIDs type and mechanism
Type = anti platelet
Mechanism = COX 1 inhibitor, reversible
NSAIDs ½ life
2 - 10 hours
NSAIDs reversal
PLTs
NSAIDs anesthesia recs
stop 24-48 hours before
NSAIDs lab monitoring
none
Clopidogrel type and mechanism
type = anti platelet
mechanism = ADP receptor antagonist
Clopidogrel ½ life
7 hours
Clopidogrel reversal
PLTs
Clopidogrel anesthesia recs
Stop 5 - 7 days
Clopidogrel lab monitoring
none
LMWH type and mechanism
type = anti coagulant
mechanism = factor IIa and Xa antagonism (indirectly)
LMWH ½ life
4.5 hours
LMWH reversal
Protamine but partial reversal
LMWH anesthesia recs
stop 12-24 hours before
LMWH lab monitoring
Anti- Factor Xa assay
Heparin ½ life
1.5 hours
Heparin reversal
Protamine
Heparin anesthesia recs
stop 6 hours before
Heparin lab monitoring
PTT
Warfarin type and mechanism
type = anticoagulant
mechanism = Vitamin K epoxide reductase antagonist
Warfarin ½ life
2-4 days
Warfarin reversal
Vitamin K
FFP
Recombinant Factor VII
Warfarin anesthesia recs
Stop 4-5 days before
Warfarin lab monitoring
PT
t-PA type and mechanism
type = Fibrinolytic
mechanism = plasminogen activator
t-PA ½ life
5 min
tPA reversal
Anti-fibrinolytic (ex. = TXA)
tPA lab monitoring
PT/PTT
Name 3 plasmin inhibitors
- TXA
- Aproptinin (trasylol)
- Epsilon aminocapropic acid (Amicar, EACA)
Aproptinin (Trasylol) class, MOA and use
class = anti fibrinolytic
MOA = slows breakdown of fibrin
used in cardiac surgey
Epsilon Aminocaproic Acid (Amicar, EACA) MOA and use
Blocks plasmin from binding with fibrin, therefore prevent the breakdown of fibrin and keeps the clot intact
- used with hemorrhage
