Bleeding Drugs

Question 1

Who uses these medications?

Answer 1

 stroke, MI, AF, artificial heart valves

 Cardiac stents

 Orthopedic surgical patients

• knee and hip prosthetics
• increased risk for DVT/PE

Question 2

 Incomplete blockage of a coronary artery

 Small amount of heart muscle damaged

Answer 2

Non-ST-elevated MI (NSTEMI)

Question 3

 Blockade not large enough or doesn’t persist long enough

 No permanent damage to heart muscle

Answer 3

Unstable angina

Question 4

 A coronary artery is completely blocked
 Muscle supplied by blocked artery damaged
 “Large” heart attack

Answer 4

ST-elevated MI (STEMI)

Question 5

Antiplatelet drugs are used to…..

Answer 5

educe
risk of stroke and other adverse
thromboembolic events

Question 6

What is a PCI?

Answer 6

percutaneous coronary intervention or stent

Question 7

Two kinds of stents

Answer 7

 Bare-metal and drug-eluting stents

Question 8

Aspirin causes irreversiblepla

Answer 8

irreversibleplatelet aggregation

 effects last for life of the platelet = 7-10 days

Question 9

Aspirin Indications

Answer 9

 prevention of thromboembolic conditions
 history of MI (lowers risk)
 history of stroke

Question 10

Discontinuing the use of aspirin increases

Answer 10

mortality by 8 times for 30 days

Question 11

Short-term and long-term dual antiplatelet
therapy with aspirin and a thienopyridine is
required to help ensure that stents…

Answer 11

remain patent and free from

thrombosis

Question 12

these drugs cause irreversibleeffects on

platelets

Answer 12

Antiplatelet Drugs

Question 13

Antiplatelet Drug names

Answer 13

 ticlopidine (Ticlid) *Canadian
 clopidogrel (Plavix)
 prasugrel (Effient)
 ticagrelor (Brilinta)

Question 14

How long to wait after DES implantation if they

are not at high risk of bleeding

Answer 14

12 months

Question 15

 inhibit the final common pathway for platelet
adhesion, activation and aggregation
 inhibits the binding of fibrinogen, von
Willebrand factor and other adhesive
molecules

Answer 15

Platelet Glycoprotein IIb/IIIa Receptor Antagonists (fibrinogen receptor inhibitors)

Question 16

dabigatran (Pradaxa)

Answer 16

 FDA approved October 2010
 Thrombin inhibitor
 Prodrug = lacks anticoagulant activity
- converted in vivoto active dabigatran

Question 17

dabigatran (Pradaxa)

Advantages and disadvantages

Answer 17

 advantages: no monthly monitoring; fewer drug-
drug and drug-diet interactions

 disadvantages: very expensive; twice daily
dosing

Question 18

thromboprophylaxis for
hip/knee replacement; nonvalvular atrial
fibrillation

Answer 18

apixaban (Eliquis)

Question 19

thromboprophylaxis for hip/knee
replacement; unstable angina; non-ST
segment elevation MI; treatment of DVT/PE

Answer 19

fondaparinux (Arixtra)

Question 20

thromboprophylaxis for hip/knee
replacement; treatment of DVT; nonvalvular
atrial fibrillation; treatment of PE

Answer 20

rivaroxaban (Xarelto) –

Question 21

best documented
alternative to warfarin and aspirin for stroke
prevention in the broad population with AF

Answer 21

apixaban (Eliquis)

Question 22

good alternative to

warfarin in AF; most data in DVT and ACS

Answer 22

rivaroxaban (Xarelto)

Question 23

Major concerns with Novel Direct Anticoagulants

Answer 23

 Major concerns
 Risk for hemorrhage
 Absence of a specific reversal agent

Question 24

Most important factors to consider during surgical dental treatment with Novel Direct Anticoagulants

Answer 24

 Degree of renal function
 Complexity of procedure
 Risk for bleeding due to concomitant causes