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Therapeutics > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

What are injectable anticoagulants?

A

Unfractionated heparin
LMWH (enoxaparin, tinzaparin)
Activate antithrombin III

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2
Q

What does antithrombin do?

A

Inactivtes some clotting factors and thrombin by complexing with series protease of the factors

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3
Q

When are heparins used?

A

Immediate action
Used to prevent thrombosis (venous unstable angina) and used to prevent blood clotting on collection
Used whilst warfarin takes effect
Unfractioned heparins monitored via APTT

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4
Q

How do you monitor unfractionated heparin?

A

Activated partial thromboplastin time (APTT)
Don’t need coagulation monitoring
Platelets: >5 days heparin can lead to thrombocytopenia

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5
Q

How is a DVT diagnosed?

A

Painful swelling in calf
USS
Blood test- increased levels of D-dimer

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6
Q

What is D-dimer?

A

Product of fibrinolysis and is raised in thrombosis

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7
Q

What are risk factors for DVT/PE?

A 
Surgery
Pregnancy
Oestrogens 
Malignancy
MI/heart failure
Obesity
Age >40
Coagulation disorders
Immobility
Past history of VTE
Trauma
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8
Q

What is warfarin?

A

Oral anticoagulant
Vitamin K antagonist
Vitamin K essential for production of prothrombin and factors VII, IX and X
Warfarin blocks vitamin K reductase, needed for fit K to act as a cofactor

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9
Q

Which patients is warfarin used in?

A

Replaced heart valves
AF
PE
DVT

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10
Q

What is prothrombin time?

A

Time for coagulation following addition of thromboplastin

Prolonged by abnormalities of factors VII, X, V, II or I

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11
Q

How is warfarin monitored?

A

Monitored by INR (prothrombin time) with a specific target value and the dose is adjusted
Normal INRs are around 1
INR is increased by impaired clotting due to warfarin and liver disease (as the liver produced coagulation factors)

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12
Q

What do increased actions of INR lead to?

A 
Bleeding:
Gastric
Cerebral
Haemoptysis
Blood in faeces
Blood in urine
Easy bruising
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13
Q

How often should INR be monitored when using warfarin?

A

2x per week then increase interval gradually (max interval is 12 weeks)

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14
Q

Why is warfarin be reversed?

A

Reversed with vitamin K
If patient is bleeding
Has a very high INR (>8-10)
Warfarin overdose

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15
Q

What counselling is given to patients when taking warfarin?

A

Take at 6pm
If they miss a dose they should not take 2 doses together and should inform doctor at the next blood test
Inform a HCP they are taking it
Advise young women not to become pregnant
Alcohol may be consumed in moderation

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16
Q

How should patients change their diet whilst on warfarin?

A

Avoid excessive consumption of green vegetables (particularly spinach, Brussel sprouts, letuce, broccoli) and beetroot and liver
Changes to diets rich in vitamin K should be discussed with a HCP, as a change of warfarin may be required

17
Q

What should patients report when taking warfarin?

A 
Haemoptysis
Blood in faeces
Blood in urine 
Nose bleeds (>20-30 mins)
Easy bruising 
Skin changes (necrosis)
Consult doctor if they have diarrhoea or vomiting for 2 days or more
18
Q

How does pregnancy affect coagulation?

A

Produces a thrombophilic state in the mother
Prevents post partum haemorrhage
Thrombophilia, decreased venous return due to the gravid uterus and immobility during labour
Mothers with artificial heart valves?

19
Q

Why should you avoid warfarin in pregnancy?

A 
Teratogenic
Chondroplasia punctata (altered bone growth)
Optic atrophy
Mental retardation 
Avoid in trimester 1 and 3
Favour LMWHs
20
Q

What should you give patients who need immediate anticoagulation?

A

Heparin

Warfarin is delayed- 3 days

21
Q

What is dabigatran?

A 
Oral thrombin inhibitor 
Prevents thromboembolism 
Less bleeding than warfarin 
Fewer drug interactions 
Does not require monitoring
22
Q

What’s rivaroxaban?

A

Oral inhibitor of activated factor X

23
Q

The concurrent use of an enzyme inducer (rifampicin) does what in a patient taking warfarin?

A

Therapeutic failure

Plasma concentrations of warfarin are likely to be decreased

24
Q

What is a contra-indication to thrombolytic (fibrinolytic drugs)?

A

Gastric ulcers

Risk of bleeding

Therapeutics (17 decks)

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