Week 5 -antiplstelets And Anticoagulations

Question 1

Anticoagulants vs antiplatlets

Answer 1

Anticoagulants: work in the venous system - not blood thinners
Targets clotting factors which are necessary for clot formation
Considered to be a more aggressive treatment option then antiplatelet

Antiplatelets
- work in the arterial system
- no role in treat/prevent venous thromboembolism
- Inhibit the ability of platelets to stick together and form a thrombus
- used in ACS and history of symptomatic atherosclerosis
Drugs include:
-aspirin
- clopidogrel

Question 2

Anticoagulants

Answer 2

Indications
- treat/prevent VTE and PE
- treat/prevent stroke / TIA
- ACS

Include
- warfarin
He
Rains
Novel oral anticoagulants

Question 3

Warfarin

Answer 3

Narrow therapeutic index
INR monitoring - aim for 2-3 in non valvuvlaf AF
Drug interactions
Pregnancy
Food interactions
Keep to same brand and strength
Alcohol

Question 4

Heparin’s

Answer 4

When compared to warfarin:
Shorter half life = more rapid onset of effect/clearance
Use in caution in decreased renal function
Contraindications in severe hepatic impairment or disease
Can cause thrombocytopenia

Question 5

Factor XA inhibitors

Answer 5

Include: apixaban, rivaroxaban
No monitoring of INR
Not suitable in severe renal impairment
No antidote
When compared to warfarin = short half life = more rapid clearance

Question 6

Clopidogrel (antiplatelets)

Answer 6

Bind to the platelets ADP receptor to inhibit platelet aggregation
- works for the lifetime of the platelet
- prodrug

Usually well tolerated
- rare but serious ADRs: skin reactions, multi-organ hypersensitivity, anaemia, thrombocytopenia, neutropenia
Avoid grapefruit juice