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Treatment Anticoagulation (VIT K Antagonist eg. Warfarin (Factors…
Treatment Anticoagulation
VIT K Antagonist eg. Warfarin
Factor 2,7 ,9, 10 and Prothrombin
Vit K required for activation factors
Inhibits Protein C
Long half life
Highly protein bound
Bridging required (higher than 5 CHADVASC)
INR Monitoring
Different INR for different indications
Factors affecting INR
Diarrhoea/Vomiting
OTC
Antibiotics
Alcohol
Vit K Rich Foods
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Keep at higher end
Twice/Week clinics
5mg for 3 days*
NOAC
Background
Once daily constant dose
No bridging required
Shorter Half Life
Reversible antagonist of activated factor X (Xa)
Check Renal function
Dabigitran
Pro Drug
Onset within 30 mins
Renal excretion (avoid <30mL/min)
Not for Dossette box
Antidote: Idarucizumab
150mg BD
GI Bleeds :warning:
Rivaroxaban
30mins onset of action
Take with food. Increases bioavailibility
Renal excretion (avioid <15mL/min)
AF: 20mg OD
VTE:15mg BD 3 weeks then 20mg OD
CYP3A4 inhibitors :warning:
Apixaban
Onset 1 to 4 hours
Renal excretion avoid <15mL/min
AF: 5mg BD
VTE: 10mg BD for 1 week then 5mg BD
Avoid severe liver impairment :warning:
Edoxaban
60mg OD
Renal excretion avoid <15mL/min
Avoid severe liver impairment :warning:
Counselling
A - Adherance
B - Bleeding
C - Creatinine Clearance
D - Drugs (other)
E - Examine BP / Bloods
F - Finalize Prescription
LMWH eg. Enoxaprin
Factor
Activate Antithrombin
Once Daily dosing
Long half life
Heparin
Continous infusion
Short half life
Indirect thrombin inhibitor
Dose monitoring
Antidote: Protamine
Heparin Induced Thrombocytopenia :warning:
More thrombogenic
Platelet drops
More risk of clotting
Can be reversed
Immune response