Flashcards in Other Anti-coags Deck (33)
Factor Xa inhibitors (oral), MOA
-MOA: oral direct factor Xa inhibitor (inhibits free and clot-bound factor Xa)
Clinical indications of factor Xa
-Prevention of VTE in pts undergoing THA/TKA (tx for at least 10-14d, preferably 35d)
-Prevention of stroke/systemic embolism in pts with non-valvular AF
-Prevention and tx of VTE
Clinical indication for Rivaroxaban
When should you start the oral factor Xa inhibitors? How's the bleeding risk?
-Start after surgery
-Bleeding risk LESS than warfarin (apixaban has the least)
What is the reversal agent for the oral Xa inhibitors?
Drug interactions for oral Xa inhibitors
-Most are substrates of P-GP and 3A4
-Don't use with other anticoags
LMWH drug and MOA
-MOA: antithrombin mediated inhibition of factors Xa > IIa
LMWH clinical indications
-DVT prophylaxis of hip/knee/abd sxs, restricted mobility
(use this unless you can't, lots of advantages)
What is a limitation of LMWH?
Harder to dose in CKD and obese pts
Drug monitoring for LMWH
-Monitor for anemia/signs of bleeding (H/H)
-No anticoag monitoring necessary, best during tx rather than prophylaxis
What is the reversal agent for LMWH?
Common ADRs of LMWH
-Injection site pain and hematoma
-Hemorrhage less than UFH
-Thrombocytopenia < UFH
-HIT rarely (<1%)
Synthetic analog of Heparin, MOA
Fondaparinux, anti-thrombin mediated inhibition of factor Xa
Clinical indications of Fondaparinux
-DVT prophylaxis of hip/knee/abd sxs
What is a unique advantage of Fondaparinux?
Long half life (qd dosing)
What is the drug monitoring, drug interactions, and ADRs to be aware of in Fondaparinux?
-Monitor: H/H, SCr, anti-Xa assay
-Interactions: other antiplatelets/anticoags/NSAIDs -> bleeding
What are the direct thrombin inhibitors (oral, IV)
-IV: Argatroban, Bivalirudin
MOA of Dabigatran
Synthetic, non-peptide, direct thrombin (IIa) inhibitor, inhibits both clot bound and circulating thrombin -> decreases thrombin-stimulated platelet aggregation
Clinical indications of Dabigatran
-Prevention of stroke in pts with non-valvular AF
-Prevention of VTE in pts undergoing THA/TKA
-VTE tx (not initial)
What is the reversal agent for Dabigatran?
What is a unique pearl about the storage of Dabigatran?
Sensitive to moisture, should be kept in original bottle and tightly capped
Dabigatran + __________ = increase hemorrhage
ADRs of Dabigatran
What is the only approved product for pts with HIT?
Argatroban has a very short half life and is safest in a patient with what?
CKD, metabolized by the liver
-Approved for ACS managed with PCI
-Pts with/at risk of HIT undergoing PCI
Older fibrinolytic, MOA
-Alteplase aka recombinant tissue-type plasminogen activator (tPA)
-MOA: initiates local fibrinolysis by binding to fibrin in a thrombus, converts entrapped plasminogen to plasmin
Clinical indications of alteplase
-Acute pulm embolism
-Acute ischemic stroke
-Central venous cath clearance
-Acute peripheral arterial occlusive disease