Therapeutic dosing and monitoring of warfarin (Coumadin) & Types of anticoagulants- mechanisms of action and indications for use Blood coagulation mechanisms: 1. injury exposes subendothelial matrix proteins (i.e. collagen and von Willebrand factor) result in platelet adherence and activation, secr...
Therapeutic dosing and monitoring of warfarin (Coumadin) & Types of anticoagulants- mechanisms of action and indications for use
Blood coagulation mechanisms:
1. injury exposes subendothelial matrix proteins (i.e. collagen and von Willebrand factor) result in platelet adherence and
activation, secretion and synthesis of vasoconstrictors and platelet-recruiting and activating molecules [thromboxane A2 is synthesized from
acid within platelets; platelets secrete ADP (a platelet aggregator) and serotonin (stimulates aggregation and vasoconstriction)] = platelet
plug
2. Coagulation system cascade is activated resulting in thrombin generation and a fibrin clot, which stabilizes the platelet plug
*1 & 2 occur simultaneously.
Indirect Thrombin MOA Dosage Monitoring Clinical Applications Toxicities & Reversal
Inhibitors
Unfractionated heparin 1. Binds to Continuous IV Activated partial Bleeding, hair loss, HIT
(UFH, HMW) antithrombin and infusion bolus: 80- thromboplastin time (heparin induced
inhibits clotting factor 100 units/kg followed (aPTT or PTT), CBC w/ thrombocytopenia)
proteases thrombin, by 15-22 units/kg per platelet count Long-term: osteoporosis,
IXa, and Xa hour spontaneous fractures,
Low dose mineralocorticoid
prophylaxis: 5000 deficiency
units subq Q8- 12h Protamine Sulfate: for
every 100 units heparin
remaining in patient,
1mg protamine sulfate
given
IV
Low-Molecular-Weight 1. Binds to Prophylactic: 30-40mg 1mg protamine sulfate
Heparin antithrombin and Q or BID Unnecessary may partially neutralize
Enoxaparin/Lovenox inhibits clotting factor Full dose: 1mg/kg 1 mg enoxaparin
Dalteparin proteases thrombin subq Q12h
Tinzaparin and Xa
, Fondaparinux 1. binds antithrombin, Once daily, subq Unnecessary No reversal agent
inhibiting factor Xa
Warfarin MOA Dosage Monitoring Clinical Applications Toxicities & Reversal
Warfarin/Coumadin 1. blockade of 5-10mg, usually 5- Prothrombin time Teratogenic effects
, gamma-carboxylation 7mg/d (PT) and INR PO/IV Vitamin K1, FFP,
resulting in Education: increased INR gaal:2-3 prothrombin complex
incomplete vitamin K intake INR goal w/ artificial concentrates (KCentra)
coagulation of factor (leafy greens) reduce heart valves: 2.5-
molecules that are anticoagulant effect 3.5
inactive of warfarin
Oral Direct Factor Xa MOA Dosage Monitoring Clinical Applications Toxicities & Reversal
Inhibitors
(aka DOAC)
Rivaroxaban/Xarelto 1. inhibit factor Xa Rivaroxaban: Unnecessary Rivaroxaban:
Apixaban/Eliquis prophylactic dose -stroke prevention in
Edoxaban post hip surgery: patients w/ afib w/o
10mg PO x35d vascular heart disease
prophylactic dose post
-prevention of VTE
knee surgery: 10mg
following hip/knee
PO x12d
DVT/PE tx: 15mg BID surgery
x3wk, then 20mg -VTE treatment
QD x3-6mon
Apixaban:
Apixaban: -stroke prevention in
prophylactic dose patients w/ afib w/o
post hip surgery: vascular heart disease
2.5mg PO BID x35d -prevention of VTE
prophylactic dose post following hip/knee
knee surgery: 2.5mg surgery
PO BID x12d
-VTE treatment
DVT/PE tx: 10mg BID
x3wk, then 5mg BID
x3- 6mon Edoxaban:
- stroke prevention in
Edoxaban: VTE/afib tx: patients w/ afib w/o
60mg QD vascular heart disease
-VTE treatment
following heparin tx
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Courseprof. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $18.99. You're not tied to anything after your purchase.
