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Questions and Answers
Which of the following drugs are direct Factor XA inhibitors?
Which of the following drugs are direct Factor XA inhibitors?
Warfarin is a Vitamin K antagonist.
Warfarin is a Vitamin K antagonist.
True
What is the antidote for Dabigatran?
What is the antidote for Dabigatran?
Praxbind
Heparin is preferred for use during ___.
Heparin is preferred for use during ___.
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What is the primary use of Clopidogrel?
What is the primary use of Clopidogrel?
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What is one major side effect of Fondaparinux?
What is one major side effect of Fondaparinux?
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The major adverse effect associated with heparin includes ___.
The major adverse effect associated with heparin includes ___.
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Study Notes
Anticoagulants and Antiplatelets
- Anticoagulants reduce the formation of fibrin by inhibiting synthesis of clotting factors, including factor X and thrombin, or by inhibiting the activity of clotting factors.
Mechanisms of Anticoagulants
- Warfarin: inhibits synthesis of clotting factors, including factor X and thrombin; reversal with Vitamin K.
- Heparin and enoxaparin: activate antithrombin.
- Direct Thrombin Inhibitor: dabigatran; reversal with praxabind.
- Direct Factor XA Inhibitors: fondaparinux, rivaroxaban, apixaban, edoxaban; reversal with andexxa for rivaroxaban and apixaban.
Antiplatelets
- ASA, clopidogrel, and vorapaxar: inhibit platelet aggregation.
Heparin
- Inactivates thrombin and factor Xa.
- Administered subcutaneously, with rapid onset.
- Preferred for use during pregnancy, in situations requiring rapid onset of effects, and in open heart and renal dialysis.
- Low-dose therapy used to prevent postoperative venous thrombosis and in DIC.
- Adverse effects: hemorrhage, HIT; caution with renal and liver patients.
- Contraindications: low platelet count, uncontrollable bleeding, recent eye/brain/spinal surgery, lumbar puncture, or regional anesthesia.
- Monitoring: PTT or anti-Xa level.
- Antidote: protamine sulfate.
Low-Molecular-Weight (LMW) Heparins
- Fixed single dose, no PTT monitoring required, and can be used at home.
- First-line therapy for DVT prevention and treatment.
Fondaparinux
- Enhances activity of antithrombin to cause inhibition of factor Xa.
- Uses: DVT prevention post-surgery, PE with warfarin, DVT with warfarin.
- Use with caution in renal patients; do not use with patients weighing <65 kg.
- Adverse effects: GI bleeding, hemorrhagic stroke, renal impairment.
P2Y12 Inhibitors
- Clopidogrel, prasugrel, and ticagrelor: used for secondary prevention of atherothrombotic events in patients with ACS.
- Taken orally, similar to ASA.
- In ACS patients, clopidogrel should always be combined with ASA (75-325 mg daily).
Vorapaxar
- Approved for use with aspirin or clopidogrel in reducing CV events in patients with history of MI or PAD.
Dipyridamole
- Approved for prevention of thromboembolism after heart valve replacement.
- Always combined with warfarin; fixed dose combo with ASA is indicated for recurrent stroke.
Cilostazol
- Prevents platelet aggregation and vasodilates.
- Used for intermittent claudication.
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Description
This quiz covers the mechanisms of action of anticoagulants, including warfarin, heparin, and direct thrombin inhibitors, in the context of ST-Elevation Myocardial Infarction (STEMI). Learn about the different types of anticoagulants and their reversal agents.
