Anticoagulants
Unfractioned heparin
LMWH
Direct thrombin inhibitors
Factor Xa inhibitor
Vitamin K antagonist
- Smaller molecules = more predictable
- Interferes with factor X
- Subq or IV
- Levels checked with antifactor assay
- Prevention of DVT 0.2-0.4u/mL
- Absorbed slowly
- Half life is 3-5 hours
- Given daily or twice daily
- No routine monitoring
- Can be checked with antifactor Xa activity 4 hours after subq administration (peak)
- Get baseline PT/INR, aPTT, CBC, serum creatinine
- IV or subq
- Binds to antithrombin and platelets which prevents clumping, it suppresses the formation of fibrin
- Used for arterial thrombi
- Onset is immediate
- Half life is 90 minutes
- Levels are checked with aPTT
- Therapeutic range is 1.5-2.5 X the mean control value of 20-30 seconds
- Baseline Hgb, Hct, and platelets
- HIT is a possible reaction caused by antibodies to platelet factor and heparin causing multiple venous thrombi
- Monitor for a fall in platelets below 100X10-9/L, or 50% below baseline
- Monitor for intracranial, intraoccular, pericardial bleeding (fatal) along with petichiae bruising, headache, red or black tarry stools, discolored urine, or change in vital signs
- Antidote is protamine sulfate 1mg/100 units of heparin
- Up to 50mg IV can be given over 10-15 minutes to prevent a drop in B/P and bradycardia
- Hypersensitivity can includes uticaria, fever and chills
- enoxaparin, dalteparin, tinzaparin
- lepirudin, bivalirudin, desirudin
- Made from leech saliva
- Get baseline Hgb, Hct, and draw levels periodically
- No antidote
- Interacts directly with thrombin
- IV bolus or infusion
- Used for HIT reactions or risk for HIT reactions
- Monitored by aPTT
- 1.5-2.5 X control
- fondaparinux sodium
- Used for the prevention of DVT in ortho surgeries
- Given Subq daily
- No routine testing
- warfarin
- Antidote is vitamin K
- Fresh frozen plasma, clotting factor concentrates, and recombinant factor VII can
- Interferes with vitamin K metabolism and slows the rate of protein synthesis
- Used for acute ischemic stroke, persistent A-fib, acute MI with ventricular thrombus, mitral valve disease, mechanical heart valves, DVT and PE
- Diet must be consistent with vitamin K consumption
- Heparin is used to bridge into warfarin since the full effect takes 8-15 days
- Levels are checked with PT/INR
- Normal PT is 10-13 seconds
- Goal is to have 1.5-2.0 times the control
- Mechanical heart valve 2.5-3.5
- PE and A-fib 2.0-3.0
- Levels must be checked monthly