Anticoagulant Therapy

Warfarin (coumadin )

INR used to monitor therapeutic levels.

Give at the same time each day.

Variations of certain genes (e.g., CYP2CP, VKORC1) may influence response to drug.

Antidote: Vitamin K. For VKA-related bleeding, treatment with prothrombin complex concentrate (human) (Kcentra), IV vitamin K and/or fresh frozen plasma is recommended. given PO

dalteparin (Fragmin) enoxaparin (Lovenox)

Routine coagulation tests typically not needed.

Monitor CBC count at regular intervals.

Do not expel air bubble from prefilled syringe. If giving subcutaneously, inject deep into subcutaneous tissue (preferably into the abdominal fatty tissue or above the iliac crest), inserting the entire length of the needle. Hold skinfold during injection but release before removing needle. Do not aspirate. Do not inject IM. Do not rub site after injection. Rotate sites.

Reduced dosage needed in patients with renal problems. Use extreme caution in patients with a history of HIT.

Antidote: Protamine reverses the effects of LMWH. given Sub Q

Heparin Sodium

Therapeutic effects measured at regular intervals by the aPTT or ACT.

Monitor CBC counts at regular intervals and titrate according to parameters.

Follow administration guidelines for LMWH if giving subcutaneously.

IV given as an adjunct for existing blood clots.

SQ given prophylactically to prevent the development of clots.

Antidote: Protamine reverses the effect of UH.

apixaban (Eliquis)

All approved for VTE prevention and treatment.

Routine coagulation tests not needed. Monitor CBC and creatinine at regular intervals.

May cause thrombocytopenia.

Do not expel air bubble before giving fondaparinux. Follow administration guidelines as described for subcutaneous LMWHs.

Antidote: Andexanet alfa (Andexxa) reverses the effects of all Factor Xa inhibitors.

bivalirudin (Angiomax)

Therapeutic effect measured by ACT or aPTT. Used in patients with HIT who need anticoagulation.

Antidote: None. IV

dabigatran

Argatroban therapeutic effect measured by aPTT. No routine coagulation tests needed for dabigatran.

Used in patients at risk for or with HIT, for VTE prevention in joint replacement surgery, stroke prevention in nonvalvular atrial fibrillation.

Antidote: Idarucizumab (Praxbind) reverses the effect of dabigatran only. PO