Anticoagulant Drugs Differences Quiz

Thrombolytic Therapy

• The primary purpose of thrombolytic therapy is to dissolve blood clots.
• Anticoagulant drugs are given following thrombolytic therapy to prevent re-clotting.

Alteplase

• Alteplase is primarily metabolized in the liver.
• The primary action of alteplase in thrombolytic therapy is to break down fibrin, a component of blood clots.
• Alteplase is considered first-line therapy for acute ischemic stroke.
• Alteplase is primarily eliminated from the body through the liver.
• The main adverse effect of alteplase is bleeding.
• Alteplase is not recommended in patients over 80 years of age due to the increased risk of bleeding.
• Intracranial hemorrhage is a contraindication for alteplase use.

Heparin

• The antidote for heparin overdose is protamine sulfate.
• Mast cells and basophils contain endogenous heparin.
• The primary action of heparin in the body is to inhibit thrombin, preventing the formation of blood clots.
• Heparin takes 2-3 hours to act when given subcutaneously.
• Low doses of heparin are recommended for prophylaxis of deep vein thrombosis (DVT).
• Enoxaparin, an anticoagulant drug, binds to antithrombin and is administered for prophylaxis of DVT in people undergoing hip or knee surgery.

Warfarin

• Warfarin acts in the liver to prevent the synthesis of vitamin K-dependent clotting factors.
• Fondaparinux, an anticoagulant drug, poses a bleeding risk in patients with renal dysfunction.
• The primary adverse effect associated with Warfarin therapy is bleeding.
• Warfarin has a BLACK BOX WARNING for the risk of causing major or fatal bleeding.
• Warfarin is most useful in long-term prevention or management of venous thromboembolic disorders.
• The goal of heparin therapy in disseminated intravascular coagulation (DIC) is to prevent further thrombosis.
• Platelet counts should be monitored during heparin therapy due to the risk of thrombocytopenia.
• Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening complication of heparin administration.
• Uncontrolled bleeding is a contraindication for the use of heparin.
• Heparin dosage is regulated during therapy based on activated partial thromboplastin time (aPTT).

Low Molecular Weight Heparins (LMWHs)

• The primary advantage of LMWHs over traditional heparin is that they have a more predictable dose response.
• Heparin does not cross the placental barrier or get secreted in breast milk.

Antiplatelet Drugs

• Clopidogrel is converted into its active form by the enzyme CYP2C19.
• Platelet inhibition essentially lasts for 7-10 days after taking clopidogrel.
• The approved loading dose range for clopidogrel is 300-600 mg.
• Elderly patients are more likely to experience bleeding and complications with antiplatelet drugs like clopidogrel.
• TTP (thrombotic thrombocytopenic purpura) is a contraindication for using clopidogrel.
• Prasugrel might be recommended for CYP2C19 poor or intermediate metabolizers who cannot benefit adequately from clopidogrel.
• Dual antiplatelet therapy with clopidogrel and aspirin is recommended for 1-12 months for patients receiving implants with a bare-metal stent or a drug-eluting stent.

Prasugrel

• Prasugrel differs from clopidogrel in terms of metabolism activation, requiring only one-step conversion to its active form.
• The TRITON-TIMI 38 trial demonstrated different clinical responses to prasugrel and clopidogrel in individuals who are poor metabolizers of CYP2C19.

Ticagrelor

• Ticagrelor differs from clopidogrel and prasugrel in terms of receptor blockade, binding reversibly to the P2Y12 receptor.
• The common adverse effects associated with ticagrelor use are dyspnea, bleeding, and bradycardia.
• In cases of life-threatening or serious bleeding with the use of ADP receptor antagonists like ticagrelor, platelet transfusion may be required.

Warfarin

• The primary action of Warfarin in the body is to inhibit the synthesis of vitamin K-dependent clotting factors.
• Warfarin differs from vitamin K in terms of action, as vitamin K promotes the synthesis of clotting factors.
• The antidote for Warfarin overdose is vitamin K.
• The liver is primarily responsible for the metabolism of Warfarin.
• Renal impairment affects Warfarin excretion, leading to increased drug levels.
• The main use of Warfarin is in the prevention and treatment of thromboembolic disorders.
• A lower dose of Warfarin may be required in older patients due to decreased metabolism and increased sensitivity.
• The liver eliminates Warfarin from the body.
• Critically ill patients require concurrent treatment with heparin or LMWHs due to the increased risk of bleeding.
• The primary adverse effect associated with Warfarin therapy is bleeding.
• The US FDA has issued a BLACK BOX WARNING for Warfarin due to the risk of bleeding.
• Warfarin is classified as category X for use during pregnancy, meaning it is contraindicated.