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27 Cards in this Set

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Antithrombotic Therapy
Anticoagulants
Antithrombotic Therapy
Anticoagulants
A- Unfractionated heparin (UFH)
B- Low molecular weight heparins (LMWH)
Enoxaparin (Lovenox)
C- Fondaparinux (Arixtra)
D- Argatroban
E- Warfarin (Coumadin)
Anticoagulants- mechanism
Heparin
Anticoagulants- mechanism
Heparin
activates antithrombin which inhibits factors IIa (thrombin), Xa, others
Anticoagulants- mechanism Low molecular weight heparin
Low molecular weight heparin
enoxaparin (Lovenox)
fragments of UFH which strongly inhibit factor Xa greater than factor IIa
Fondaparinux (Arixtra)Anticoagulants- mechanism
Fondaparinux (Arixtra)
synthetic, directly inhibits factor Xa
Anticoagulants- mechanism
Argatroban
Anticoagulants- mechanism
Argatroban
synthetic, direct thrombin inhibitor
Anticoagulants- mechanism
Warfarin (Coumadin)
Warfarin (Coumadin)
interferes with the hepatic synthesis of vitamin-K dependent clotting factors (II, VII, IX, X)
Anticoagulants- Indication, Dose, Monitoring (IDM)
Heparin
(I)acute MI, thromboembolism, ischemic stroke. (D)treatment dose- infusion on heparin protocol.(SE)bleeding, TCP, HIT. (M)labs-aPTT, stool guaiac, UA, H/H, platelets, S&S of bleeding
Heparin propylaxis of thromboembolism
prophylaxis dose-5000 units SC every 8-12 hrs. (SE)bleeding, TCP, HIT. (M) labs, aPTT, stool, UA, H/H, platelets, S&S of bleeding
Lovenox (IDM)
acute MI, ACS, thromboembolism. (D)treatment dose- img/fg SC every 12 hrs or 1.5 mg/kg SC every 24 hrs. (SE) bleeding. (M) labs, stool, UA, H/H, platelets, S&S of bleeding
Lovenox prophhylaxis of thromboembolism
propholaxis dose- 30mg SC every 12hrs or 40mg SC every 24. (SE)bleeding. (M) labs, stool, UA, H/H, platelets, S&S of bleeding
Arixtra
treatment of thromboembolism. (D)5-10mg (based on body wt. range)SC once daily. (SE) bleeding, thrombocytopenia. (M)labs, stool, UA, H/H, platelets, S&S bleeding
Arixtra prophylaxis of thromboembolism
(D)2.5mg once daily. (SE) bleeding, thrombocytopenia(M)labs, stool, UA, H/H, platelets, S&S bleeding
Agratroban
(I)heparine-induces thrombocytopenia, ischemic stroke, acute MI. (D)completely different dosing according to indication. (SE) bleeding. (M)labs, stool, UA, H/H, platelets, S&S bleeding
Couamadin
(I)throboembolism (Afib, post-MI, venous TE, heart valves). (D)loading dose of 5mg then adjust according to PT/INR, goal is 2.5-3.5 , (M) S&S of bleeding
Antithrombotic Therapy
Antithrombotic Therapy
Antiplatelets
Aspirin
Clopidogrel (Plavix)
Dipyridamole (Persantine)
Dipyridamole/aspirin (Aggrenox)
Antithrombotic- mechanism
Aspirin
Antithrombotic- mechanism
Aspirin- irreversibly inhibits platelet cyclooxygenase
Clopidogrel (Plavix)- selectively, irreversibly inhibits adenosine diphosphate (ADP)-induced platelet aggregation
Dipyridamole (Persantine)- inhibits adenosine and phosphodiesterase resulting in accumulation of adenosine, adenine and cyclic AMP in the platelet which in turn inhibit platelet aggregation
Dipyridamole/aspirin (Aggrenox)- combination mechanism
AM Clopidogrel (Plavix)-
Clopidogrel (Plavix)- selectively, irreversibly inhibits adenosine diphosphate (ADP)-induced platelet aggregation
AM Dipyridamole (Persantine)-
Dipyridamole (Persantine)- inhibits adenosine and phosphodiesterase resulting in accumulation of adenosine, adenine and cyclic AMP in the platelet which in turn inhibit platelet aggregation
Dipyridamole/aspirin (Aggrenox)-
Dipyridamole/aspirin (Aggrenox)- combination mechanism
Antiplatelets- Indication, Dose, Monitoring (IDM)
aspirin
(I)ACS, acute MI, ischemic stroke, etc.(D)75-325mg once daily.(SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding
Plavix
I)ACS, acute MI, ischemic stroke, PAD. (D)75mg once daily (SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding
Dipyridamole
(I)thromboembolism prophylaxis in cardiac valve replacement and CABG. (D)75-100mg four times daily.(SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding
Aggrenox
(I)stroke prophylaxis. (D)1 capsule twice daily - do not crush.(SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding
Combination Therapy
Combination Therapy
Anticoagulants
Thromboembolism
Initially anticoagulated with
Heparin or
Lovenox or
Arixtra or
Argatroban
Overlap with warfarin until therapeutic INR
Combination Therapy
Antiplatelets
Post-MI, ACS-
Combination Therapy
Antiplatelets
Post-MI, ACS- DOC is aspirin, alternative is Plavix. But can use aspirin + Plavix in stent placement or for medical management (no PCI)
Ischemic stroke-
Primary prevention
Ischemic stroke-
Primary prevention: aspirin
unless pt w/ risk factors, then use Coumadin
Ischemic stroke- Secondary prevention
Secondary prevention: aspirin
alternatives:
Aggrenox
Plavix or Coumadin in aspirin intolerance or failed aspirin or in Afib (use warfarin)