ACS and VTE Treatment Quiz

Heparin

• Prevents conversion of fibrinogen to fibrin
• Uses: VTE prophylaxis, treatment of VTE, and ACS
• Contraindications: History of uncontrolled active bleeding, severe thrombocytopenia
• Side effects: Bleeding risk, thrombocytopenia, increased LFT's
• Antidote: Protamine

Low Molecular Weight Heparin

• Binds to AT, inhibiting Factor Xa more than Factor IIa
• Side effects: Vfib, retroperitoneal/intracranial bleeding

Factor Xa Inhibitors

• Reversible and selective inhibitor of Factor Xa, decreasing thrombin generation and thrombus formation
• Examples: Apixaban (Eliquis) and Rivaroxaban (Xarelto)
• Indications: DVT/PE treatment and prevention, nonvalvular atrial fibrillation (reduce stroke risk)
• Side effects: Bleeding risk, GI bleeding, hemorrhage, increased LFT's
• Antidotes: Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra)

Glycoprotein IIb/IIIa Inhibitor

• Inhibits platelet aggregation by binding to GPIIb/IIIa and preventing fibrinogen
• Example: Eptifibatide (Integrilin)
• Indications: Percutaneous coronary intervention, adjunct to PCI
• Contraindications: CVA within 30 days, active abnormal bleeding, surgery/trauma within 6 weeks
• Side effects: Bleeding risk, thrombocytopenia, anaphylaxis, CVA, intercranial hemorrhage

Direct Thrombin Inhibitors

• Directly inhibits thrombin (Factor IIa), binding to the active thrombin site of free and clot-associated thrombin
• Examples: Dabigatran (Pradaxa) and Argatroban
• Indications: DVT/PE treatment and prevention, nonvalvular atrial fibrillation (reduce stroke risk), thromboprophylaxis, HIT, PCI-thrombosis
• Side effects: Bleeding risk, dyspepsia, gastritis-like symptoms, anemia, hypotension, chest pain
• Antidotes: Idarucizumab (Praxbind) for dabigatran, no specific antidote for argatroban

Factor Xa Inhibitors

• Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
• Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
• Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
• Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
• Avoid grapefruit juice and CYP3A4 inhibitors.

Glycoprotein IIb/IIIa Inhibitor

• Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
• Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
• Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

Unfractionated Heparin

• Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
• Used for OA, RA, and other conditions.

P2Y12 Inhibitors

• Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
• Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
• Contraindications include active bleeding, history of stroke or TIA.
• Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
• Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

Fibrinolytics

• Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
• 2nd Generation, due to clot-specific binding.

Direct Thrombin Inhibitors

• Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
• Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
• Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
• Idarucizumab (Praxbind) is an antidote.
• Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
• Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

Factor Xa Inhibitors

• Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
• Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
• Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
• Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
• Avoid grapefruit juice and CYP3A4 inhibitors.

Glycoprotein IIb/IIIa Inhibitor

• Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
• Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
• Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

Unfractionated Heparin

• Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
• Used for OA, RA, and other conditions.

P2Y12 Inhibitors

• Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
• Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
• Contraindications include active bleeding, history of stroke or TIA.
• Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
• Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

Fibrinolytics

• Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
• 2nd Generation, due to clot-specific binding.

Direct Thrombin Inhibitors

• Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
• Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
• Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
• Idarucizumab (Praxbind) is an antidote.
• Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
• Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

Factor Xa Inhibitors

• Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
• Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
• Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
• Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
• Avoid grapefruit juice and CYP3A4 inhibitors.

Glycoprotein IIb/IIIa Inhibitor

• Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
• Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
• Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

Unfractionated Heparin

• Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
• Used for OA, RA, and other conditions.

P2Y12 Inhibitors

• Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
• Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
• Contraindications include active bleeding, history of stroke or TIA.
• Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
• Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

Fibrinolytics

• Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
• 2nd Generation, due to clot-specific binding.

Direct Thrombin Inhibitors

• Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
• Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
• Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
• Idarucizumab (Praxbind) is an antidote.
• Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
• Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

Factor Xa Inhibitors

• Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
• Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
• Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
• Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
• Avoid grapefruit juice and CYP3A4 inhibitors.

Glycoprotein IIb/IIIa Inhibitor

• Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
• Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
• Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

Unfractionated Heparin

• Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
• Used for OA, RA, and other conditions.

P2Y12 Inhibitors

• Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
• Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
• Contraindications include active bleeding, history of stroke or TIA.
• Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
• Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

Fibrinolytics

• Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
• 2nd Generation, due to clot-specific binding.

Direct Thrombin Inhibitors

• Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
• Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
• Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
• Idarucizumab (Praxbind) is an antidote.
• Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
• Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.