Patients on Anticoagulation Therapy Flashcards
(37 cards)
What is the primary objective of anti-coagulant therapy?
To prevent thrombus formation by inhibiting clotting factors.
Name the most commonly used anticoagulant categories
- Warfarin
- DOACs (e.g. dabigatran, rivaroxaban, apixaban)
What is essential for ensuring therapeutic efficacy and minimizing bleeding risks when using Warfarin?
Regular monitoring of INR.
What should be assessed pre- and post- DOAC use?
Renal function.
What are the major haemorrhagic complications of anticoagulant therapy?
- GI bleeding
- Intracranial haemorrhage
- Severe epistaxis
Who is at increased risk for major bleeding complications from anticoagulation?
- Older patients
- Those with renal impairment
- Patients on concomitant antiplatelets
What are minor bleeding complications associated with anticoagulant therapy?
- Bruising
- Petechiae
- Gum bleeding
Do minor bleeding complications require discontinuation of anticoagulation therapy?
No.
What types of complications can arise from anticoagulant therapy?
- Haemorrhagic complications
- Thromboembolic complications
- Drug-drug interactions
- Disease interactions
How can liver disease affect anticoagulant therapy?
It can alter pharmacokinetics, increasing the risk of bleeding and thrombosis.
What is one effect of renal impairment on anticoagulant therapy?
It can increase the risk of bleeding and thrombosis.
Fill in the blank: The primary objective of anti-coagulant therapy is to _______.
prevent thrombus formation by inhibiting clotting factors.
What is dabigatran?
A DOAC used for:
1. prophylaxis of VTE post-surgery
2. prevention of stroke in non-valvular AF
Main side effect is haemorrhage/
**Not to be prescribed if eGFR < 30. **
What is the reversal agent for dabigatran?
Idarucizumab
Which DOAC is excreted by the liver (1), the kidneys (1), or faecally (2)?
Liver = Rovaroxaban
Renal = Dabigatran
Faecal = Apixaban, edoxaban
What is the reversal agent for rivaroxaban & apixaban
Andexanet alfa
What are the two types of heparin?
- Unfractionated (‘standard’) heparin
- Low molecular weight heparin (LMWH)
Unfractionated - inhibits thrombin & 4 clotting factors
LMWH- inhibits antithrombin III & factor Xa
Main adverse effects of heparin?
- bleeding
- heparin induced thrombocytopenia - osteoporosis
- hyperkalaemia
Monitoring of heparins
Unfractionated - APTT
LMWH - not routinely monitored
Indications for unfractionated heparin vs LMWH
Unfractionated:
- useful if high risk of bleeding, can be terminated rapidly
LMWH:
- standard management in VTW and ACS prophylaxis
What is heparin-induced thrombocytopenia?
Immune-mediated reaction against platelet factor 4 and heparin.
Usually presents 4-5 days post-treatment.
Despite being associated with low platelets, actually prothrombotic condition.
What are clinical clues suggesting heparin-induced thrombocytopenia?
- recent heparin use (unfractionated > LMWH)
- low platelets + new DVT/PE/thrombosis
- skin necrosis at heparin injection site
Reversal agent for heparin?
protamine sulphate
What are the indications for parenteral anticoagulation?
Prevention of VTE & management of ACS
Includes: Unfractionated heparin, LMWH, fondapurinux & direct thrombin inhibitors
