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Unfractionated Heparin Therapy
Treatment of choice to prevent _______ clots due to _______ (e.g., venous and arterial thrombosis, pulmonary embolism, thrombophlebitis, acute myocardial infarction)
Therapy involves a bolus of heparin, followed by continuous infusion.
______ must be present with levels of ____ of normal for heparin to work.
The ______ complex inhibits serine proteases, including _______. Inhibition is immediate.
Treatment of choice to prevent extension of existing clots due to acute thrombotic events (e.g., venous and arterial thrombosis, pulmonary embolism, thrombophlebitis, acute myocardial infarction)
Therapy involves a bolus of heparin, followed by continuous infusion.
Antithrombin must be present with levels of 40-60% of normal for heparin to work.
The antithrombin/heparin complex inhibits serine proteases, including Xlla, XIa, IXa, Xa, Ha, and kallikrein. Inhibition is immediate.
Unfractionated Heparin Therapy
It inhibits the conversion of ______, platelet _____, and activation of factor____
Heparin activity can be immediately ____ by administration of _____.
Monitor with _____; therapeutic range is approximately ____ times patient's baseline aPTT value prior to treatment. Dosage is adjusted accordingly.
Daily _____ should be performed on heparinized patients to monitor for _____. If detected, heparin therapy is immediately halted and different anticoagulant therapies are considered.
It inhibits the conversion of fibrinogen to fibrin, platelet aggregation, and activation of factor XIII.
Heparin activity can be immediately reversed by administration of protamine sulfate.
Monitor with aPTT; therapeutic range is approximately 1.5-2 times patient's baseline aPTT value prior to treatment. Dosage is adjusted accordingly.
Daily platelet counts should be performed on heparinized patients to monitor for heparin-induced thrombocytopenia (HIT). If detected, heparin therapy is immediately halted and different anticoagulant therapies are considered.
Warfarin (Coumadin®/Coumarin) Therapy
This _____ anticoagulant is prescribed on an outpatient basis to prevent ____ clots and recurrence of _____, an prophylactically it is often prescribed ____ to prevent ____.
Vitamin K ______
Warfarin inhibits liver synthesis of functional prothrombin group factors _____
Factor VII is affected first (short half-life) and to the greatest extent.
This oral anticoagulant is prescribed on an outpatient basis to prevent extension of existing clots and recurrence of thrombotic events, an prophylactically it is often prescribed postsurgery to prevent thrombosis.
Vitamin K antagonist
Warfarin inhibits liver synthesis of functional prothrombin group factors II, VII, IX, and X.
Factor VII is affected first (short half-life) and to the greatest extent.
Warfarin (Coumadin®/Coumarin) Therapy
Overlap with heparin therapy is common, because full anticoagulant action of warfarin is not achieved for _____ days.
Warfarin is often used for up to _____ or longer.
Monitor with ____ and ____; INR therapeutic range is _____ for most conditions.
If INR is higher with serious bleeding, ____ can be administered to reverse affects.
Overlap with heparin therapy is common, because full anticoagulant action of warfarin is not achieved for 4-5 days.
Warfarin is often used for up to 6 months or longer.
Monitor with PT and INR; INR therapeutic range is 2.0-3.0 for most conditions.
If INR is higher with serious bleeding, vitamin K can be administered to reverse affects.
Low-molecular-weight heparin
(e.g., enoxaparin sodium), ______ injection, requires _____ to work
Fixed dose response reduces the need for laboratory monitoring.
Lower risk of ______
It is mainly an _______; _____ response is reduced.
If monitoring is needed, perform _____ assay.
(e.g., enoxaparin sodium), subcutaneous injection, requires antithrombin to work
Fixed dose response reduces the need for laboratory monitoring.
Lower risk of heparin-induced thrombocytopenia (HIT)
It is mainly an anti-Xa inhibitor; anti-IIa response is reduced.
If monitoring is needed, perform anti-Xa assay.
Direct thrombin inhibitor
(e.g., argatroban, lepirudin, bivalirudin)
activates _____ only; does not require presence of antithrombin to work
Used in place of unfractionated or low-molecular-weight heparin when _____ suspected
These medications will prolong the ______.
(e.g., argatroban, lepirudin, bivalirudin)
activates thrombin only; does not require presence of antithrombin to work
Used in place of unfractionated or low-molecular-weight heparin when HIT suspected
These medications will prolong the PT, aPTT, and thrombin time.
Fibrinolytic therapy:
____ activator, _____, can be used to lyse existing clots and reestablish vascular perfusion.
These medications convert _____.
______ destroys the fibrin clot, factors ____
Affected tests include ____, fibrinogen, FDP, and D-dimer (also bleeding time because of low fibrinogen)
Tissue plasminogen activator, streptokinase or urokinase, can be used to lyse existing clots and reestablish vascular perfusion.
These medications convert plasminogen to plasmin.
Plasmin destroys the fibrin clot, factors I, V, and VIII.
Affected tests include PT, aPTT, thrombin time, fibrinogen, FDP, and D-dimer (also bleeding time because of low fibrinogen)
Antiplatelet medications (e.g., aspirin, Plavix®, ticlopidine, and nonsteroidal anti-inflammatory drugs/NSAIDS)
may be used in conjunction with other anticoagulant therapies to prevent _____
recurrence of thrombotic events
