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