Cardio Exam 2: Anti-Coags Elsaid WRITTEN NOTES

What are the different anti-coag classes? (7)

UFH, LMWH, Fondaparinux, DTIs, DOACs, Warfarin, and Non-Heparin Anticoags

UFH MOA?

Binds to ATIII and causes allosteric activation that increases Factor Xa and IIa inhibition

UFH other MOA info?

Has a long chain that binds to both ATIII and IIa

UFH Reversal?

Protamine Sulfate

UFH other info?

Causes HIT

LMWH MOA?

Has a short chain that mainly binds to ATIII and results in no bridging of ATIII and IIa (3:1 = Xa:IIa)

What are the LMWH Drugs?

Enoxaparin, Dalteparin, and Tinzaparin

Enoxaparin, Dalteparin, and Tinzaparin are _____ drugs.

LMWH

LMWH Reversal?

Protamine Sulfate

LMWH other info?

Preferred in pregnant and oncology pts, requires renal dose adjustment, and causes HIT (UFH>LMWH)

Fondaparinux MOA?

Synthetic pentasaccharide that binds only to ATIII (Factor Xa only inhibitor) bc it’s too short to bridge ATIII and IIa

Fondaparinux Other info?

Used for HIT pts

What are the DTI drugs?

Dabigatran, Argatroban, and Bivalirudin

DTI is also called the _____ inhibitor

Factor IIa

Dabigatran is a _____ drug.

DTI/Factor IIa Inhibitor

Argatroban is a _____ drug.

DTI/Factor IIa Inhibitor

Bivalirudin is a _____ drug.

DTI/Factor IIa Inhibitor

Dabigatran MOA?

oral DTI that inhibits circulating thrombin and clot-bound thrombin

Dabigatran reversal?

Idarucizumab (Praxbind) that directly binds to Dabigatran

Dabigatran other info?

Used for non-valvular A. Fib. and DVT/PE treatment

Argatroban MOA?

IV DTI that’s hepatically cleared

Argatroban other info?

Used for HIT pts with renal dysfunction

Bivalirudin other info?

Used for HIT pts with hepatic dysfunction

Bivalirudin MOA

IV DTI that’s renally cleared

DOACs are also called _____ inhibitors

Direct Oral Factor Xa

What are the DOAC drugs?

Edoxaban, Apixaban, and Rivaroxaban

DOAC Reversal?

Andexxa

Andexxa MOA?

Acts as a decoy Factor Xa protein

DOAC Other Info?

Used for Non-Valvular A. Fib. and DVT/PE pts, CYP3A4 and p-gp, and avoid pts with prosthetic heart valves

Warfarin MOA?

VKOR inhibitor

Warfarin MOA mechanism?

Inhibits VKOR, then decreases active vitamin k, then prevents activation of clotting factors

Vitamin K is a ______.

Co-factor

VKOR is a ______.

Enzyme

Warfarin Clotting Factors?

II, VII, IX, and X

Warfarin Anticoag proteins?

S and C

Warfarin Onset info?

Takes 5-7 days to work bc existing clotting factors need to be degraded 1st

Warfarin Reversal?

Kcentra/PCC (life-threatening bleeding) and Vitamin K

Warfarin Other info?

Monitor INR (2-3), CYP2C9 mutation increases sensitivity, and bridge with heparin

What are the non-heparin anticoagulants?

Fondaparinux, Argatroban, and Bivalirudin

What drugs require ATIII to work?

UFH, LMWH, and Fondaparinux

REMEMBER:

• _____ = DTIs

• _____ = DOACs

• _____ = Non-Heparin Anticoags

• _____ = Requires ATIII to Work

• _____ = Factor IIa Inhibitors

• _____ = Direct Oral Factor Xa Inhibitors

DAB, EAR, ABF, ULF, DTIs, DOACs