IRAT/GRAT Anticoagulation Brand/Generic

Unfractionated Heparin

Heparin

Unfractionated Heparin MOA

-Binds to antithrombin (your natural blood thinner) causes conformational change which increases AT activity 1,000-fold.

-Indirect inhibit thrombin (factor IIa) and Xa, prevents conversion of fibrinogen to fibrin

Unfractionated Heparin indication

prevention of VTE in hospital, Tx of VTE, Tx of ACS/STEMI

enoxaparin

Lovenox

enoxaparin MOA

-enhances antithrombin III (your natural blood thinner)-mediated inhibition of clotting proteases through conformational change which increases AT activity 1,000-fold

-strongly inhibits Xa

-higher anti-factor Xa to anti-factor IIa activity ratio

-mean 4,500 daltons

-Indirect inhibit >Xa

enoxaparin indication

PPx of VTE in hospital and Tx of VTE

Dalteparin

Fragmin

Dalteparin MOA

-LMWH analog with a molecular weight of 4,000 to 6,000 daltons

-Preferentially factor Xa inhibitor, but can also have affect on thrombin

Dalteparin indications

off-label for VTE

fondaparinux

Arixtra

fondaparinux MOA

-indirect selective inhibitor of Factor Xa

-binds to antithrombin (your natural blood thinner) causes conformational change which increases AT activity 1,000-fold

-synthetic pentasaccharide.

fondaparinux indications

PPx or Tx of VTE

Argatroban

Acova

Argatroban MOA

-IV direct thrombin inhibitor

-binds to the enzyme active site of thrombin

Argatroban indication

PPx or Tx of HITT, anticoagulation for pts with at risk for HITT undergoing PCI

Bivalirudin

Angiomax

Bivalirudin MOA

IV direct thrombin inhibitor

Bivalirudin indications

- preferred anticoagulant in urgent cardiac surgery or PCI if pt has concern for HITT

warfarin

-Coumadin

-Jantoven

warfarin MOA

-Vit K antagonist

-competitively inhibits C1 subunit of multi-unit vitamin K epoxide reductase (VKORC1) enzyme complex

-vitamin K required carboxylation (activation) of clotting factors

-decreases production of active clotting factors II, VII, IX, and X and anticoagulants Protein C and S

Warfarin indications

genetic hypercoagulopathy > antiphospholipid syndrome, mechanical valves

Dabigatran

Pradaxa

Dabigatran MOA

oral direct THROMBIN inhibitor (factor IIa)

Dabigatran indications

nonvalvular Afib, Tx of VTE, PPx of DVT/PE following hip replacement surgery

Apixaban

Eliquis

Apixaban MOA

oral direct factor Xa inhibitor

Apixaban indications

nonvalvular Afib, Tx of DVT/PE, PPx for DVT (after hip/knee replacement)

Rivaroxaban

Xarelto

Rivaroxaban MOA

oral direct Factor Xa inhibitor

Rivaroxaban indications

nonvalvular Afib, Tx of VTE, reduction in risk of major CVD events in CAD/PAD, PPx s/p knee/hip replacement

Edoxaban

Savaysa

Edoxaban MOA

oral direct factor Xa inhibitor

Edoxaban indications

nonvalvular Afib, Tx of VTE

Protamine sulfate indication

antidote for heparin

Protamine sulfate MOA

Protamine is basic with a positive charge. Heparin is acidic with a negative charge. When protamine is given, a stable complex is formed, nullifying the anticoagulant activity of both drugs

Vitamin K indications and brand name

phytonadione

-reversal for warfarin

Vitamin K MOA

Promotes liver synthesis of Factors II, VII, IX, and X

Kcentra indications and brand name

4-factor PCC

reversal for warfain

Kcentra MOA

Increases the levels of Factors II, VII, IX, and X, and protein C and S

Idarucizumab indications and brand name

Praxbind

-reversal for dabigatran

Idarucizumab MOA

Humanized monoclonal antibody fragment (Fab) that binds to dabigatran and its metabolites with ~350x the affinity of thrombin.