Heparin Anticoagulants

Question 1

Heparin

Answer 1

MoA - Complexes w/ antithrombin III –> inhibition of Xa and IIa

Monitored by APTT (2-2.5x)

IV and Subcutaneous

Ind - Surgical anticoagulation and tube flushing

Adverse - Heparin induced thrombocytopenia (HIT), Bleeding

Metab - Hepatic

Question 2

Low Molecular Weight Heparin

Answer 2

MoA - Complexes w/ antithrombin III leading to inhibition of Xa and IIa

Monitored by anti-Xa

Subcutaneous

Ind - Prophylaxis/treatment of DVT and ACS (Acute coronary syndrome)

Adverse - Bleeding

Metab - Hepatic

More bioavailable than heparin

Question 3

Fondaparinux

Answer 3

Heparin pentasaccharide

MoA - Complexes w/ antithrombin III and inhibits Xa

Subcutaneous

Ind - Management of DVT

Adverse - Bleeding

Metab - Renal (DNTK)

Can be monitored by anti-Xa (not necessary) and better bioavailability than heparain

Question 4

Argatroban

Answer 4

MoA - Directly inhibits IIa

I.V.

Ind - Anticoagulant management of HIT

Adverse - Bleeding

Metab - Hepatic (DNTK)

Question 5

Bivalirudin

Answer 5

MoA - Directly inhibits IIa

I.V.

Ind - Anticoagulant management of HIT

Adverse - Bleeding

Metab - Blood proteases (DNTK)

Question 6

Hirudin

Answer 6

MoA - Directly inhibits IIa

From leeches

I.V.

Ind -Anticoagulant management of HIT

Adverse - Bleeding

Metab - Renal/hepatic (DNTK)

Question 7

Antithrombin concentrate

Answer 7

MoA - Directly inhibits IIa

I.V.

Ind - DIC, sepsis, thrombophilia, hypercoagulable state

Adverse - None

Question 8

Protamine sulfate

Answer 8

MoA - Heparin antagonist

I.V.

Ind - Reversal of heparin effects

Adverse - bradycardia, hypotension