Venous Thromboembolism: Antiplatelets and bleeding management and antidotes(recorded lecture)

Question 1

what are the medication classes

Answer 1

COX-1 inhibitors
- aspirin
ADP receptor inhibitors
GPIIb/IIIa receptor blockers
Phosphodiesterase-3 inhibitors
- dipyridamole
Protease-Activated Receptor inhibitors

Question 2

Antiplatelet use in VTE

Answer 2

• Limited role in VTE due to increased risk of bleeding
• adjunct role to thrombolytics
• Significant role in ACS and other arterial ischemic vascular disorders

Question 3

Bleeding management steps

Answer 3

Discontinue medication
Apply manual compression
Maintain BP
Surgical or radiological intervention
Blood products (+/-) PCC (+/-) antidotes

Question 4

Target reversal drugs for bleeding management

Answer 4

UFH, LMWH : Protamine sulfate
Dabigatran : Idarucizumab (praxbind)
Factor Xa inhibitors : andexanet alfa

Question 5

Bleeding management considerations

Answer 5

• activated charcoal less than or equal to 2 hours of bleeding
• Hemodialysis : dabigatran only
  -Tranexamic acid

Question 6

Protamine sulfate use for UFH and LMWH

Answer 6

rapidly reverses the effects of heparins in life threatening hemorrhage or great heparin excess
Adverse reactions: hypotension, bradycardia

Question 7

Idarucizumab (Praxbind) use for thrombin inhibitors
MOA, adverse reactions, and monitoring schedule

Answer 7

MOA: direct binder to dabigatran
AE: delirium, constipation, hypokalemia, fever, pneumonia, and HA
Monitoring schedule
Baseline aPPT –> repeat in 2 hours –> every 12 hour until normal

Question 8

Andexanet use for Xa inhibitors

Answer 8

mimics factor Xa so it can bind to the inhibitory drugs without producing enzymatic activity