Anticoag

Question 1

LMWH eg dalteparin, tinzaparin.

Answer 1

Given SC. longer t1/2. Oncr or twice daily, no monit.
MOA- inactivs facXa.
Indics- venous TE and acute coronary synd.
probs- accumulates in renal fail.
S/E for all hep- bleeding, thrombocytopenia, OP. HyperK.
CI- bleed disord, low pl, peptic ulcer, prev hep induced thrombocytopenia, peptic ulcer, cerebral haemorrhage, sev HTN, neurosurg.

Question 2

Unfrac heparin

Answer 2

IV or SC. 13KDa. Rapid onset, short t1/2.
MOA- A glycosaminoglycan, binds antithrombin= icnr its abil to inhib thrombin, fac Xa and IXa.
Monit and adjust dose with APTT.

Question 3

Warfarin

Answer 3

Oral, once daily, LT. narr therap range.
Meas as ratio vs INR.
MOA- inhibs vit K reductase so prevs reform of active form.
CI- peptic ulcer, bleed disorder, sev HTN, preg.
Caution- eld and prev GI bleed.
Dosing- start with 10mg, test INR after 16hr. INR daily for 5d and adjust dose. Stop hep after 5d and when INR over 2 for 2d. Meas INR on alt days til stable, then weekly or less.
Targets- PE and DVT and AF stroke preven aim for INR 2-3. Prosthetic valve 3-4. 3 mnth tx for PE or DVT above knee.

Question 4

Others

Answer 4

Xa inhibs

Thrombin inhibs

Question 5

For venous TE

Answer 5

Hep intially, with warfarin.

Hep contin til INR at target therap range and until day 5 as warfarin has initial prothrombotic affect.

Question 6

Antidotes

Answer 6

UHF OD- protamine sulfate.

Warfarin- INR 4.5-8 reduce or stop til under 5. INR over 8 vit K. If bleed then prothrombin complex.