Flashcards in 3 Anticoagulants HH Oral Deck (17):
Check baseline ......(3)...... when starting warfarin
Usual loading dose for warfarin:
reduce this in.... and ...
10mg od for 2 days
(reduce in elderly and liver impaired)
2 reasons warfarin interactions are so common?
1. metabolised by cyp
2. highly bound to plasma - other protein bound drugs compete
What factors does Warfarin inhibit synthesis of?
clotting factors: II, VII, Ix, X
regulatory factors: protein C and protein S
What are the actions of
vitamin K dependent anticoagulant proteins
Why do we overlap Warfarin and Heparin
Warfarin initially decreases protein C and S faster than coagulation factors - therefor it can increase blood's tendency to coagulate when first begun
Baseline monitoring for NOACs
Do we use TED stockings from stroke patients?
No they do worse with them
UFH is rarely used now except in (2)
high bleed risk or renal failure
Why is depression risky with Warfarin?
Risk of self harm?
Why is illicit drug use risky with Warfarin?
Risk of infection and bleed
Why is uncontrolled hypertension risky with NOACs?
How to change from Warfarin to apixiban
-you would consult product literature
-Wait for the INR to drop below a certain level (~2.5)
Monitor NOACs for (5)
Bleeding & anaemia
Pregnancy and BF - avoid!
What do we try to use for managing NOAC overdose
Supportive therapy and fluid replacement to insure excretion
Consider factors, tranexamic acid, dialysis
Contraindications for NOACs
-recent GI ulceration
-neoplasm at risk bleeding
-recent brain or spinal injury
-recent brain, spinal or ophthalmic surgery
-recent intercraneal haemorrage
-cocomitant other anticoagulants