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Anticoagulation (Indications (NOACs
Treatment of DVT/PE
VTE/stroke…
Anticoagulation
Indications
NOACs
Treatment of DVT/PE
VTE/stroke primary prophylaxis in patients with risk factors (previous stroke/TIA, HTN, DM, symptomatic HF, age>75y)
VTE primary prophylaxis post-surgery
VTE secondary prophylaxis
Warfarin
VTE/stroke prophylaxis in patients with AF or rheumatic heart disease, prosthetic valves
Treatment of VTE
LMWH
Treatment of ACS, VTE, MI
MOA
NOACs
E.g. apixiban, dabigatran, rivaroxaban
FXa inhibitors or direct thrombin inhibitors
Prevents thrombin generation and thrombus development
Warfarin
Inhibits VitK dependent clotting factors (II, XII, IX, X)
and anticoag proteins C and S
LMWH
E.g. enoxaparin, tinzaparin
Binds and activates antithrombin, inactivates clotting
enzymes e.g. FXa
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Interactions
Warfarin
MANY drugs e.g. carbamazepine,
phenytoin, OCP, St Johns Wort, steroids
Cranberry juice
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Scoring systems
CHADSVASc
Assesses stroke risk; antcoag if 1+ in M or 2+ in F
CCF (1)
HTN (1)
Age 65-74y (1)
DM (1)
Stroke/TIA (2)
Vascular dis (1)
Age >75y (2)
Sex female (1)
HASBLED
Assesses bleeding risk
HTN (1)
Abnormal renal/liver (1 each)
Stroke (1)
Bleeding (1)
Labile INR (1)
Elderly (>65y) (1)
Drugs/alcohol (1)
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