L3 ANTICOAG THERAPIES Flashcards
why do patients get thromboembolism
triad
Endothelial injury – normal cause for arterial thrombus – damage to lining causing platelets to clot
Blood stasis – venous thromboembolism – bed rest cause this or logn haul flights and blood clots and if abnormal blood flow such as in AF as flow not smooth risk of blood clot
Hypercoagulability – inherited disease , thrombophilia’s or malignancy and trauma
4 steps of haemostasis
formation fo paletot plug - adhésion, aggregation, activation and secretion and thrombin
propagation of clotting - clotting cascade
termination of clotting - anti-thrombotic state
fibrinolysis and clot removal - activation of plasmin and lysis of clot and production of d-dimer and FDPs
thrombin activates what to form cross linked clot
and what other factors does it amplify
fibrinogen to fibrin and factor 13
also activates factor 11,8 and 5
what converts plasminogen to plasmin
tissue plasminogen activator
plasmin coverts the cross linked fibrin clot to
D dimer
fibrinogen degradation products ( FDPs)
what is dalteparin
heparin
prevention of a stroke with someone wit AF
DOAC more common fro AF or warfarin
mechanical heart valves - warfarin
what anticoagulant for VTE prophylaxis
lose dose LMWH
side effects of anticoagulants
bleeding
major GI bleeds
what score can you use for bleeding risk
HAS-BLED score
uncontrolled HTN and previous major bleeding
what score do you use for DVT and PE risk
WELLS score
what score for anticoagulant use in AF or stroke risk
CHA2DS2VASc
DOACs
Axpixaban, Rivaroxaban, edoxaban/dabigatran
Most people started on these not warfarin as they don’t interact with many drugs
Advanatges
- Fewerinteractions
- 6 monthly blood tests for renal fucntions
- Simpleer or patietns and doctors to prescribe
Disadvanatges
- No easy way to reverse them
- Less long term data on efficacy and safety
what do they all - what factors do they bind to
Rivaroxaban and apixaban bind directly 10a to directly inhibt it stopping it from activating prothrombin to thrombin
Dabigatran binds to thrombin itself stopping it having that amplicficaiton effect on coagulation cascade
common side effect of dabigatran
dyspepsia - common side effect ( and hepatobillairy disease)
what do heparins do
bind to anti-thrombin therefore increasing the inhibition of thrombin
how is LMWH given
subcutaneous
how Is unfractioned heparin given
IV
side effects of heparin
bleeding heparin induced thrombocytopenia hypokalaemia osteoporosis accumulate in renal failure
what anticoagulant teratogenic in preg
warfarin - inhibits action of vit k
warfarin interacts with what
antibiotics, analgesics anticoagualtns anticonvulsants antidepreessants anti-platelet drugs
reversal of warfarin what do you do
vit k slow effet
prothrombin complex concentrates - octaplex
what instance anticoag is required what do you give
heparin - one of the 3
when slower anticoag required what do you give
warfarin and DOACs
during pregnancy you give LMWH and then what
warfarin after pregnancy
examples of antiplatelts
Antiplatelet – clopidogrel , aspirin and dipyridamole
examples of thrombolytics
tissue plasminogen activator
67 women with AF PMH OF HTN, T2D DH: RMAPRIPIL AND METFORMIN AND NKDA Cha2ds2-vasc score is 4 and has-bled score 1 What anticoagulant drug
Rivaroxaban – no bleeding history and ease of dosing regime and check renal function first
ECG shows ST elevation in anteroseptal leads
STEMI
Caused by occlusion of coronary arteries – warning of angina due to arthrosclerosis
antiplatelts used morein arterial disease
hip replacement - and saddle embolus in Pulmonary artery
need urgent thrombolytic
when to use DOAC
DVT , PE , AF
when to use heparin
DVT, PE , VTE prophylaxis , haemodialsysi vascular sugeries
when to use warfarin
DVT, PE ,AF< mechanical prostetheic heart valves
to monitor DOAC use check the renal function twice a year
INR for warfarin
what for heparin
APTTR if infusing
reversal for heparins
protamine sulphate
