Cardio: Anticoags & Dyslipidemia

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Last updated 7:18 AM on 7/1/26
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17 Terms

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Heparin

Antithrombin

Site: blood (no renal excretion)

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Warfarin

  • Inhibit synthesis of Protein C/S

  • Site: liver

  • MOA: inhibit VKOR —> deplete vitamin K —> prevent activation of clotting factors II, VII, IX, X, S, C

  • Indication: DVT/PE, thromboembolic complications, atrial fibrillaiton

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Parenteral vs Oral Agents

  • UFH

  • LMWH

  • Vitamin K

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Indirect Inhibitor MOA

Inhibit clotting factors Ila & Xa —> bind a stable 1:1 complex

—> Acts at the antithrombin —> inactivating Factor X and II

  • Heparin (UFH)

  • LMWH

  • Fondaparinux (inhibit Xa only)

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Unfractionated Heparin (UFH)

  • 5- saccharide sequence —> allosteric activation —> bind to ATIII (antithrombin) —> inhibit Xa and IIa

  • 18+ saccharide length for thrombin inhibition

  • MOA: enhances ATIII ability to inactivate IIa & Xa

    • (is still a type of indirect inhibitor)

    • Short half-life

    • Higher risk of bleeding

  • ADE: Thrombocytopenia

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Low Molecular Weight Heparin Drugs

  • Enoxaparin (Lovenox)

  • Dalteparin

  • Tinzaparin

  • MOA: bind to ATIII —> inhibit Xa and IIa

  • ADE: Thrombocytopenia

  • SubQ

  • DVT/PE prevention | Pregnant patients & Oncology

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What class causes heparin induced thrombocytopenia?

UFH & LMWH

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Fondaparinux MOA

Indirect inhibitor (bind on ATIII) —> only INDIRECTLY targets Xa

  • Synthetic source

  • Long half-life

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Direct Thrombin Inhibitors

MOA: inhibit circulating and clot-bound thrombin

Drugs:

  • IV:

    • Argatroban

      • Reduce dose in hepatic dissease

    • Bibalirudin

      • Reduce dose in renal disease

  • Oral:

    • Dabigatron (Preadax)

  • Indication:

    • DVT/PE

    • Atrial fibrillation

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Direct Factor Xa Inhibitor

  • Drugs:

    • Rivaroxaban

    • Apixaban

    • Edoxaban

  • Treat:

    • Nonalvular AF

    • DVT/PE

    • Oncology

  • CrCl < 30 mL/min

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Vitamin K Process

Vitamin K —> [oxidize] —> Vitamin K epoxide —> VKOR restores Vitamin K

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Reversal Agent for Dabigatran

Idarucizumab (Praxbind)

  • Humanized mouse monoclonal antibody

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Reversal Agents for Warfarin

  • Vitamin K

  • Kcentra

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Protamine

Reversal agent for Heparin and Enoxaparin

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Andexxa

Reversal agent for Rivaroxaban and Apixaban

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NEXT LECTURE - DYSLIPIDEMIA

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