Blood Coagulation Modifiers: Therapeutic Use & Adverse Effects

Question 1

• Intravenous heparin drips are used to treat DVT’s, pulmonary embolism and acute MI.
• Subcutaneous injections are used prophylactically to prevent deep vein thrombosis (DVT)
• Inhibits the clotting sequence. It does not break down existing clots, but it prevents them from becoming larger.

Answer 1

Therapeutic Use: Heparin (unfractionated)

Question 2

• Antithrombotic, interferes with the clotting cascade.
• Prevention and treatment of DVT

Answer 2

Therapeutic Use: Low Molecular Weight Heparin

Question 3

• Prevention and treatment of DVT or Pulmonary Embolism; Prevent/Treat thrombotic complications from Atrial Fibrillation and/or Cardiac Valve Replacement; Reduce complication risks after an MI.
• Inhibits synthesis of Vitamin K (an essential component for clotting)

Answer 3

Therapeutic Use: Vitamin K inhibitors (warfarin/Coumadin)

Question 4

Prevention and treatment of DVT or PE. Combined with aspirin to ↓ risk of cardiovascular (CV) events in those with coronary artery disease (CAD) or peripheral artery disease (PAD).

Answer 4

Therapeutic Use: Direct Oral Anticoagulants

Question 5

• Reduces rate of stroke and MI in those with established PAD or hx. of recent MI/stroke
• inhibits platelet aggregation

Answer 5

Therapeutic Use: Anti-platelet

Question 6

• High risk of bleeding, GI or cerebral hemorrhage
• risk of heparin-induced thrombocytopenia (HIT) or Heparin induced thrombocytopenia and thrombosis (HITT)-happens with 30% or more drop below a patient’s baseline platelet level.
• CONTRAINDICATIONS:
  o History of Heparin Induced Thrombocytopenia (HIT)
• Allergy to pork products

Answer 6

Adverse Effects: Heparin

Question 7

• Bleeding, risk of hemorrhage, thrombocytopenia, Heparin Induced Thrombocytopenia (HIT) or Heparin Induced Thrombocytopenia with Thrombosis (HITT)
• Caution with kidney disease

Answer 7

Side Effects: Low Molecular Weight Heparin

Question 8

BLACK BOX WARNING: Epidural or spinal hematomas may occur in patients who on this drug and receiving epidural anesthesia or spinal puncture. Paralysis may result.

Answer 8

Low molecular Weight heparin

Question 9

• Use with caution in those with liver disease
• Bleeding, renal damage, and risk of bleeding higher in pts. With liver disease.

CONTRAINDICATIONS:
- Pregnant women except for those with mechanical heart valves.
-Many contraindications including hemorrhagic tendencies or blood dyscrasias, recent or contemplated surgery of the CNS or eye, or traumatic surgery resulting in large open surfaces

Answer 9

Vitamin K Inhibitor

Question 10

BLACK BOX WARNING: May cause major or fatal bleeding.

Answer 10

Vitamin K Inhibitors

Question 11

Risk of fatal bleeding

Answer 11

Direct Oral Anticoagulants

Question 12

BLACK BOX WARNING:
Epidural or spinal anesthesia greatly increases the potential for spinal or epidural hematoma, subsequent long term or permanent paralysis.

Answer 12

Direct Oral Anticoagulants

Question 13

Increase risk of bleeding

Answer 13

Anti-platelet

Question 14

BLACK BOX WARNING: Reduced effectiveness for patient referred to as “CYP2C19” poor metabolizers.

Answer 14

Anti-Platelet