{"id":9648,"date":"2021-12-28T17:54:55","date_gmt":"2021-12-28T15:54:55","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/anticoagulant-therapy-and-monitoring\/"},"modified":"2022-01-01T22:33:24","modified_gmt":"2022-01-01T20:33:24","slug":"anticoagulant-therapy-and-monitoring","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/anticoagulant-therapy-and-monitoring\/","title":{"rendered":"Anticoagulant therapy and monitoring"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Classification<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Anticoagulants<\/li><li>Anti-platelet agents<\/li><li>Thrombolytic agents<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Anticoagulants<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Hirudin<\/li><li>Heparin<\/li><li>Fondaparinux<\/li><li>Vitamin K antagonists (coumarin)<\/li><li>Direct oral anticoagulants (DOACs)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Hirudin<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Hirudin and its derivatives are natural anticoagulants isolated from the saliva of leeches. They are <strong>direct thrombin inhibitors<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Hirudin <\/strong>(natural)<\/li><li><strong>Lepirudin <\/strong>(recombinant hirudin)<\/li><li><strong>Bivalirudin <\/strong>(+antiplatelet activity)<\/li><li><strong>Argatroban <\/strong>(small-sized molecule)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Used in cardiac catheterization (as a replacement for GP IIb\/IIIa antagonists), intravenously in the case of heparin-induced thrombocytopenia (HIT), and topically for local hematomas.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Heparin<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Heparins are sulfated polysaccharide polymers that catalyze the binding of antithrombin III to clotting factors and inactivate them.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Indirect thrombin inhibitors<\/strong><\/li><li>Divided into<strong> unfractionated heparin<\/strong> (UFH), and <strong>low-molecular-weight heparin<\/strong> (LMWH, for example, <strong>enoxaparin<\/strong>)<\/li><li>UFH is more potent against thrombin<ul><li>Monitored using APTT.<\/li><\/ul><\/li><li>LMWH has a longer half-life, safer, and is more potent against FXa<ul><li>Monitored by <\/li><\/ul><\/li><li>Used IV\/SC in surgeries and acute cases requiring rapid anticoagulation.<\/li><li>It can be used in pregnancy (doesn&#8217;t cross the placental barrier).<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Heparin-induced thrombocytopenia<\/strong> is a life-threatening condition in which antibodies are produced against heparin-PF4 (platelet factor 4, a soluble factor produced by platelets that bind to heparin) complexes, leading to massive platelet activation, thrombosis, and thrombocytopenia.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Fondaparinux<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Fondaparinux is chemically similar to LMWH; it is a FXa inhibitor administered IV\/SC.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Vitamin K antagonists<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Vitamin K antagonists inhibit the enzyme vitamin K epoxide reductase.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Derivatives of coumarin<\/li><li>Monitoring using INR values<\/li><li>Used in the past PO for longer-term treatment of coagulation disorders (rarely used today).<\/li><li>Not in use during pregnancy (passes the placental barrier).<\/li><li>In the case of bleeding, freshly-frozen plasma or oral vitamin K should be supplemented.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Direct oral anticoagulants<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Previously known as NOACs (new oral anticoagulants), are direct inhibitors of thrombin (<strong>dabigatran<\/strong>), or FXa (<strong>apixaban<\/strong>, <strong>rivaroxaban<\/strong>, and <strong>edoxaban<\/strong>).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>No monitoring is required<\/li><li>The preferred treatment in the long-term treatment of coagulation disorders. Used PO (as their name suggests).<\/li><li>Rivaroxaban is the only DOAC that can be taken once daily.<\/li><li>Idarucizumab is an antidote to dabigatran, used if rapid inactivation of the agent is required.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Anti-platelet agents<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Aspirin<\/strong><\/li><li><strong>ADP-receptor antagonists<\/strong><\/li><li><strong>GP IIb\/IIIa inhibitors<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Aspirin<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<p class=\"wp-block-paragraph\">Aspirin is an irreversible inhibitor of COX enzymes. In platelets, it prevents the production of thrombaxane.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Not used as primary prophylaxis, with a minor benefit as secondary prophylaxis (100mg\/day PO).<\/li><li>Used in AMI (300mg chewable tablets).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">ADP-receptor antagonists<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<p class=\"wp-block-paragraph\">ADP-receptor antagonists inhibit the P2Y12 receptor found on the surface of platelets, preventing their activation.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Clopidogrel (75mg\/day)<\/li><li>Prasugrel (10mg\/day)<\/li><li>Ticlopidine<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">GP IIb\/IIIa inhibitors<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<p class=\"wp-block-paragraph\">GP IIb\/IIIa inhibitors prevent the interaction of platelets with vWF and fibrinogen. They are reserved for post-operative anticoagulation (PCI), and given IV.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Abciximab (monoclonal antibody)<\/li><li>Eptifibatide<\/li><li>Tirofiban<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Monitoring<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><tbody><tr><td>Hirudin<\/td><td>Ecarin clotting time (ECT)<\/td><\/tr><tr><td>UFH<\/td><td>APTT<\/td><\/tr><tr><td>LMWH<\/td><td>Anti-Xa<\/td><\/tr><tr><td>Fondaparinux<\/td><td>Anti-Xa <\/td><\/tr><tr><td>Warfarin<\/td><td>INR (target in most cases: 2.5)<\/td><\/tr><tr><td>Apixaban<\/td><td>Anti-Xa<\/td><\/tr><tr><td>Rivaroxaban<\/td><td>Anti-Xa<\/td><\/tr><tr><td>Enoxaban<\/td><td>Anti-Xa <\/td><\/tr><tr><td>Dabigatran<\/td><td>Dilute thrombin time<\/td><\/tr><\/tbody><\/table><figcaption>Monitoring of anticoagulants.<\/figcaption><\/figure>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Anticoagulants<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Hirudin<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Heparin<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Fondaparinux<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Vitamin K antagonists<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Direct oral anticoagulants<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Anti-platelet agents<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Aspirin<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">ADP-receptor antagonists<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">GP IIb\/IIIa inhibitors<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Monitoring<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Classification Anticoagulants Anti-platelet agents Thrombolytic agents Anticoagulants Hirudin Heparin Fondaparinux Vitamin K antagonists (coumarin) Direct oral anticoagulants (DOACs) Hirudin Hirudin and its derivatives are natural anticoagulants isolated from the saliva of leeches. They are direct thrombin inhibitors. Hirudin (natural) Lepirudin (recombinant hirudin) Bivalirudin (+antiplatelet activity) Argatroban (small-sized molecule) Used in cardiac catheterization (as a replacement [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":12,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9648","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Anticoagulant therapy and monitoring &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/anticoagulant-therapy-and-monitoring\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/anticoagulant-therapy-and-monitoring\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/anticoagulant-therapy-and-monitoring\\\/\",\"name\":\"Anticoagulant therapy and monitoring &#8211; 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