Chapter 34: Anticoagulation Flashcards
Coagulation involves activation of ____ & the clotting cascade
Platelets
All of the clotting factors have an inactive and active form. Once activated, a clotting factor will activate the next clotting factor in the sequence until ___ is formed
fibrin
Which drugs are direct factor Xa inhibitors
rivaroXAban
apiXAban
edoXAban
betriXAban
Which drug is an indirect factor Xa inhibitor
Fondaparinux
Which drugs are IV direct thrombin inhibitors & which drug is an oral direct thrombin inhibitor
IV - arbatroban, bivalirudin
PO- dabigatran
What are the major differences between warfarin and DOACs
- DOACs = less DDI, less or comparable bleeding, and a shorter half-life compared to warfarin
- DOACs are dosed based on the indication and kidney/liver function while warfarin is dosed based on INR
- Use DOACs for stroke ppx in AFib if the CHA2DS2-VASc score is >/= 2 (men) or >/= 3 (women); BUT if there is moderate-severe mitral stenosis or mechanical heart valve, use WARFARIN
- Use DOACs for VTE treatment, BUT if the pt has cancer use LMWH
Primary organization that publishes guidelines for anticoagulation
American College of Chest Physicians (CHEST)
Warfarin drug class
Vitamin K antagonist
Vitamin K is required for the carboxylation (activation) of which clotting factors
II, VII, IX and X
2, 7, 9, 10
INR is affected by many drugs and changes in
dietary vitamin K
UFH, LMWH, and fondaparinux MOA
work by binding to antithrombin (AT), which inactivates thrombin (factor IIa) and other proteases (like factor Xa) involved in blood clotting & prevents the conversion of fibrinogen to fibrin
Direct thrombin inhibitors MOA
block thrombin directly (factor IIa), decreasing the amount of fibrin available for clot formation
Why are the IV direct thrombin inhibitors (argatroban and bivalirudin) clinically important
They do not cross-react with HIT antibodies
What is the DOC once HIT develops in the hospital setting
IV argatroban
Dabigatran brand name
Pradaxa
Which organization requires policies and protocols to properly initiate and manage anticoagulant therapy
The Joint Commission’s National Patient Safety Goals
Which lab could signify that bleeding is occurring while on an anticoagulant
an acute drop in hemoglobin
Which drugs/conditions can cause bruising
Chronic steroids, thrombocytopenia/clotting disorder, Cushing’s syndrome, malnutrition, fracture/sprain, infection
Which drugs/conditions can cause a hematoma
on abdomen from LMWH injection that was rubbed (do not rub), or an epidural or spinal hematoma in a patient using LMWH or DOAC who is given neuraxial anesthesia or a spinal punture
What can an upper GI bleed present as
coffee-ground emesis (vomit) or dark and tarry-looking stools
Esophageal bleeding occurs from
varices (bleeding veins, with liver cirrhosis), chronic reflux (esophagitis, Barrett’s)
How does stomach bleeding occur
from ulcers (e.g., NSAID-induced)
How does duodenal bleeding occur
from ulcers (e.g., H. pylori-induced)
The farther the bleeding site is from the anus, the ___ (lighter/darker) the stool
darker