Anticoagulation Flashcards
Which drugs bind to AF?
UF, LMWH, fondaparinux
What does AT do?
inactivates thrombin and other proteases involved in blood clotting, including factor Xa LMWHs inhibit factor Xa more specifically
MOA of warfarin?
vitamin K antagonist
What factors are involved in clotting?
factors II, VII, IX, X
MOA of direct thrombin inhibitors?
block thrombin directly, decreasing amount of fibrin
What is the choice for HIT?
argatroban
What are factor Xa inhibitors?
apixaban, betrixaban, edoxaban, rivaroxaban
MOa of UFH
binds to AT which then inactivates thrombin (factor IIa) and factor Xa and prevent conversion of fibrinogen to fibrin
UFH prophylaxis of VTE?
5,000 units SC Q8-12H
UFH treatment of VTE?
80 units/kg IV bolus and then 18 units/kg/hr infusion
UFH treatment of ACS/STEMI
60 units/kg IV bolus and then 12 units/kg/hr
What is the antidote for UHF and LMWH?
protamine 1 mg per 100 units
LMWH prophylaxis of VTE?
30 mg SC Q12h or 40 mg daily
LMWH treatment of UA/NSTEMI?
1 mg/kg Q 12H or 1.5 mg/kg SC daily
LMWH treatment of STEMI?
30 mg IV bolus and 1 mg/kg SC
Which medications can increase bleeding risk with UFH and LMWH?
anticoagulants, antiplatelet, herbals, NSAIDs, SSRI, SNRI, thrombolytics
What is HIT?
immune mediated IGG drug reaction that is associated with a high risk of venous and arterial thrombosis
HIT can lead to?
further platelet activation and causes a release of PF 4 and other pro coagulant micro-particles (prothrombotic state)
When does HIT usually start?
5-14 days and platelet drop 50%
HIT treatment?
Stop all forms of heparin and LMWH and warfarin and admin vitamin K –> argatroban –> do not start warfarin until platelet have recovered to at least 150,000
Bivallrudin is preferred in ?
urgent cardiac surgery or PCI
MOA of fondaparinux?
injectable synthetic pentasaccharide that selectively inhibits factor Xa via antithrombin AT
When to give apixaben 2.5 mg BID?
2 of the following: >80 yrs, <60 kg, SCr> 1.5
Eliquis
apixaban
