A N T I C O A G U L A N T S

A N T I C O A G U L A N T S

1. MOA

   • HIGH MOLECULAR WEIGHT HEPARINS
     • SIGNIFICANT inhibition of Xa & IIa • • • MINOR inhibition of VIIa, IXa, & XIIa • • • Active clotting factors INACTIVATED • • • INDIRECT thrombin inhibitor • • • enhances effects of antithrombin III
     • HEPARIN
   • LOW MOLECULAR WEIGHT HEPARINS
     • ENHANCES the effects of antithrombin III • • • SIGNIFICANT inhibition of Xa • • • Some inhibition of IIa • • • Active clotting factors INACTIVATED
     • ENOXAPARIN • • Lovenox
     • DALTEPARIN • • Fragmin
   • VITAMIN K ANTAGONIST
     • Interacts with Vit K cycle • • • Factor II, VII, IX, & X • • • INHIBITS Vit K epoxide reductase ( VKORC1 ) which converts Vit K to its activa form ( KH2 ) → → No longer a cofactor of carboxylase → → less K → Less K dependent clotting factors produced → ALSO inhibits protein C and S
     • WARFARIN • • Coumadin
   • FACTOR Xa INHIBITORS
     • ACUTE
       • FONDAPARINUX • • Atrixa
       • Augments function of ATII • • Significant inhibition of Xa only • • Active clotting factors inactivated (Only Xa)
     • CHRONIC
       • DOES NOT AFFECT ANTITHROMBIN • • • Directly inhibits Factor Xa by BLOCKING the active site
       • APIXABAN • Eliquis • • • • RIVAROXABAN • Xarelto • • • • EDOXABAN • Sayvasa • • • • BETRIXABAN • Bevyxxa
   • DIRECT THROMBIN INHIBITORS
     • DABIGATRAN • Pradaxa • • • • ARGATROBAN • • • • BIVALIRUDIN • Angiomax • • • • DESIRUDIN • Iprivask
     • DIRECTLY inhibits Factor IIa ( Thrombin ) by binding the active site
   • FIBRINOLYTICS
     • Breaks up clots by converting plasminogen to plasmin
     • ALTEPASE • Activase / Cathflo

2. INDICATIONS

3. MONITORING

   • REQUIRED MONITORING
     • HEPARIN
       • APTT (ACTIVATED PARTIAL THROMBOPLASTIN TIME) • • • GOAL = 1.5 - 2.5 CONTROL RANGE
   • NO REGULAR - REQUIRED MONITORING

4. INTERACTIONS

5. CONTRAINDICATIONS

   • CONTRAINDICATED IN CRCL < 30 ML/MIN
     • DABIGATRAN (- PRADAXA -)
     • FONDAPARINUX (- ATRIXA -)

6. AGENT - AGENT CONVERSION

7. FORMULATIONS

   • ORAL
     • WARFARIN
     • APIXABAN
     • RIVAROXABAN
     • EDOXABAN
     • BETRIXABAN
     • DABIGATRAN
   • S Q
     • ENOXAPARIN
     • DALTEPARIN
     • HEPARIN - NOT COMMON
   • IV
     • HEPARIN
     • FONDAPARINUX
     • ARGATROBAN
     • BIVALIRUDIN
     • DESIRUDIN
     • ATLEPASE
     • RETEPLASE
     • TENECTEPLASE

8. DRUG SPECIFIC POINTS

9. ADRs

10. COUNSELING

11. REVERSAL AGENTS

12. MEDICATION CLASS

    • HIGH MOLECULAR WEIGHT HEPARIN (HMWH)
      • UNFRACTIONATED HEPARIN (UFH)
    • LOW MOLECULAR WEIGHT HEPARINS
      • ENOXAPARIN - (LOVENOX)
      • DALTEPARIN - (FRAGMIN)
    • COURMARIN ( - VIT K - ) DERIVATIVE
      • WARFARIN ( - COUMADIN - )
    • FACTOR Xa INHIBITORS
      • FONDAPARINUX ( - ARIXTRA - )
      • APIXABAN ( - ELIQUIS - )
      • RIVAROXABAN ( - XARELTO - )
      • EDOXABAN ( - SAVAYSA - )
      • BETRIXABAN ( - BEVYXXA - )
    • DIRECT THROMBIN INHIBITORS
      • DABIGATRAN ( - PRADAXA - )
      • ARGATROBAN
      • BIVALIRUDIN (- ANGIOMAX -)
      • DESIRUDIN (- IPRIVASK -)
    • FIBRINOLYTICS
      • ATLEPASE (- ACTIVASE / CATHFLO -)
      • RETEPLASE (- RATEVASE -)
      • TENECTEPLASE (- TNKase -)

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