Anti Platelet and Anti Coagulant

Question 1

Indications for Antiplatelet Therapy

Answer 1

Secondary prevention of atherothrombolic event in ACS, Angina, PAD, those undergoing PCI
Secondary prevention of CVS events in MI, Stent implantation, stroke or TIA

Question 2

What antiplatelet regiment is given after an ACS?

Answer 2

Aspirin >300mg stat, 75mg od
+
Clopidogrel 300-600 stat, 75mg od

Question 3

Why is prasugrel more effective than clopidogrel?

Answer 3

It is not affected by generic variation of CYP450

There’s only one step to convert

Question 4

Risk of Prasugrel

Answer 4

Increased risk of bleeding due to increased efficacy

Question 5

Contraindications of antiplatelets

Answer 5

Active bleed

GI ulcer

Question 6

GI protection w/ DAPT and history of reflux

Answer 6

PPI: avoid omeprazole if clopidogrel
avoid lansoprazole
USE PANTOPRAZOLE

Question 7

GI protection w/DAPT no history of Reflux

Answer 7

H2 antagonist: Ranitidine, reduce if eGFR <60

Question 8

Indications for DOACs and Warfarin

Answer 8

AF
Treatment of PE and DVT
Option for VTE prophylaxis

Question 9

What to do before starting Warfarin?

Answer 9

Bridge with LMWH (dalteparin) and start warfarin which takes 3-4 days to take effect

Question 10

What factors does warfarin affect?

Answer 10

Factor:
8
9
10
Prothrombin 2

Question 11

Antidote for Warfarin

Answer 11

Vitamin K

and one extra

Question 12

Advantages of DOAC

Answer 12

No need for monitoring

Question 13

Disadvantages of DOAC

Answer 13

No antidote (is there an antidote now?)

Question 14

Orally available DOACs

Answer 14

Dabigatran
Apixaban
Rivaroxaban
Edoxaban

Question 15

Through what mechanism does DARE work?

Answer 15

Directly inhibits FXa

Question 16

What is dabigatran licenced for?

Answer 16

DVT

PE