Hematopoietic Agents and Anemia Flashcards
Heparin or unfractionated heparin (UFH)
Binds antithrombin iii to prevent activation of thrombin and several other clotting factors
Monitor with aPTT
Heparin-induced Thrombocytopenia (HIT)
occurs due to formation of antibodies against platelet-factor 4 and heparin complexes
Paradoxical INCREASED risk of thrombosis
Low-molecular weight heparins (LMWH)
- enoxaparin, dalteparin
-more specific inhibitors of factor Xa, reduced binding to plasma proteins cells:
-more predictable dose-response
-longer half-life
-lower risk of HIT and osteopenia
-monitoring not routinely recommended
Reversal agent for Heparin
Protamine sulfate
Warfarin
Inhibits vitamin-k dependent clotting factors 7, 9, 10, 2 in the liver as well as protein C and S
Monitor with INR
Warfarin prescribing considerations
-safe in patients with renal dysfunction
-many drug-drug, drug-food, and drug-lifestyle interaction
-not recommended for use in pregnancy
Reversal agent for Warfarin
Phytonadione (Mephyton)
Direct-acting Oral Anticoagulants (DAOCs)
Direct thrombin inhibitor:
-Dabigatran (Pradaxa)
Factor Xa-inhibitors:
-Apixaban (Eliquis)
-Edoxaban (Savaysa)
-Fivaroxaban (Xerelto)
DOAC indications per FDA
Dabigatran, rivaroxaban, and apixaban: Afib, prevention and treatment of DVT/PE, and postop DVT thromboprophylaxis
Edoxaban: afib( CrCl < 95 mL/min) and DVT/PE treatment
NONE are approved for use in patients with mechanical heart valves
DOACs that need bridging
edoxaban and dabigatran need bridging with LMWH for 5 days
DOACs that do NOT need bridging
Rivaroxaban and apixaban
Dabigatran reversal agent
idarucizumab (Praxbind)
apixaban and rivaroxaban reversal agent
andexanet alfa (Andexxa)
edoxaban reversal agent
andexanet alfa off label
Which anticoagulant should be used in pregnant women and lactating women
Pregnant- LMWH
Lactating- warfarin
