ANTIPLT:THROMBOTIC:COAGULANT.docx

ANTI-PLT/ANTI-THROMBOLYTICS/ANTICOAGULANTS/STEMI Anticoagulants reduce the formation of fibrin - By inhibiting synthesis of clotting factors including factor X and thrombin (warfarin) - By inhibiting the activity of clotting factors: factor Xa, thrombin or both - Drugs that activat...

ANTI-PLT/ANTI-THROMBOLYTICS/ANTICOAGULANTS/STEMI Anticoagulants reduce the formation of fibrin - By inhibiting synthesis of clotting factors including factor X and thrombin (warfarin) - By inhibiting the activity of clotting factors: factor Xa, thrombin or both - Drugs that activate antithrombin: heparin and enoxaparin - Vitamin K antagonist: warfarin; reversal Vit K - Direct Thrombin Inhibitor: Dabigatran; reversal praxabind - Direct Factor XA Inhibitors: fondaparinux, rivaroxaban (Xarelto), apaxiban (Eliquis), edoxaban; andexxa for reversal of rivaroxaban and apaxiban - Antplt: ASA, clopidogrel, Voropaxar +-----------------------------------------------------------------------+ | ANTITHROMBIN | +=======================================================================+ | Heparin: | | | | \- inactivates thrombin and factor Xa | | | | \- SubQ, rapid onset | | | | \- Preferred for use during pregnancy (does not cross the placenta) | | and in situations that require rapid onset of effects PE, DVT | | | | \- also used for open heart and renal dialysis (prevents clots in | | devices) | | | | \- low dose therapy is used to prevent postop venous thrombosis, also | | used for DIC | | | | \- AE: hemorrhage and HIT, caution w/renal and liver pts | | | | \- contra: low plt and uncontrollable bleeding, recent | | eye/brain/spinal sx, lumbar puncture or regional anesthesia | | | | \- monitor PTT or anti-Xa level | | | | \- ANTIDOTE: protamine sulfate | | | | LMW heparins (enoxaparin and daleparin) | | | | \- fixed single dose and do not require PTT monitoring can be used at | | home | | | | \- first line therapy for DVT prevention/tx | | | | Fondaparinux | | | | \- enhances activity of antithrombin to cause inhibition of factor Xa | | (acts indirectly) | | | | \- uses: DVT prevention post Sx, PE w/warfarin, DVT w/warfarin | | | | \- use w/caution in renal patients. Do not use w/pt weighting \65 | | | | \- AE: GI bleeding, hemorrhagic stroke, renal impairment | | | | Clopidogrel, prasugrel, and ticagrelor: | | | | \- used for secondary prevention of atherothrombotic evens in pts | | with ACS (unstable angina or MI) | | | | \- taken orally, much like asn | | | | \- in ACS pts clopidogrel should always be combined with asprin | | (75-325 mg daily) | | | | Vorapaxar: | | | | \- approved use w/aspirin or clopidogrel in reduction of CV events in | | pts w/hx of MI or PAD | | | | Dipyridamole: | | | | \- only approved for prevention of thromboembolism after heart valve | | replacement. | | | | \- always combined w/warfarin. 75-100mg 4x/day | | | | \- fixed dose combo w/aspirin is indicated for recurrent stroke | | | | Cilostazol: | | | | \- prevents plt aggregation and vasodilates | | | | \- intermittent claudication | +-----------------------------------------------------------------------+