NPX Complete: Anticoagulation 1.0
1.What are anticoagulants indicated for: Tx/Px of which disease states:
Tx/Px: VTE
Tx: ACS
Px: STK 2'2 AF
2.IV anticoags are used mainly for: Tx: ACS
Tx/ Px: of VTE
3.PO anticoags are used mainly for: Tx/ Px: of VTE
Px: STK 2'2 AF
4.What activates the coagulation cascade: Blood vessel
injury Blood stasis
Pro-thrombic conditions
5.What is blood stasis: Stopping or slowing down of blood
6.What do all anticoagulants essentially inhibit the formation of: They
inhibit the formation of fibrin
7.How does the cascade work starting with Factor Xa: Xa cleaves
prothrombin into thrombin
Thrombin cleaves fibrinogen into fibrin which forms a clot
8.Which drugs increase the risk of bleeding: NSAIDs, SSRI, SNRI
9. What drugs increase clotting risk: Estrogen and SERMs
10.Heparin-induced thrombocytopenia (HIT):
11.What is HIT: An immune mediated (IgG) drug rxn seen with UFH/
LMWH A prothrombic state
Note: Antibodies form against heparin bound platelets
12.How is HIT assessed: 4Ts Score:
Thrombocytopenia, Time, Thrombosis, oTher
13.What is Thrombocytopenia: An unexplained drop in platelets (>50%)
from BL
1/
20
, NPX Complete: Anticoagulation 1.0
14.Time: Platelet drop within 5-10 days or
Within hours in patients given heparin in the last 3 months
15.Thrombosis: Newly suspected or confirmed thrombosis which are
necrotizing/ not necrotizing
16.What to do if HIT is suspected/ confirmed: STOP UFH/ LMWH and
Warfarin ( give vitamin K)
17.Why is warfarin d/c in HIT: Warfarin + low PLT = gangrene and
necrosis
18.When should warfarin be restarted: When the patients PLT recover to
>150,000
19.What dose should warfarin be initiated at: A low dose 5 mg and
overlap for at least 5 days with the INR WNL for 24h
20.When is Bivalirudin given: Cardiac surgery or PCI in patients with a Hx
of HIT
21.What is Bivalirudin: Direct thrombin inhibitor
22.What drugs are used to tx HIT: Rapid acting non-heparin
anticoagulants Argatroban + Bivarudin (Angiomax)
Fondaparinux (off label)
23.Drugs General:
24.What is antithrombin (AT): An endogenous anticoagulant
25.What does it do: Inactivates thrombin (factor IIa) and other
proteases (Xa) involved in clotting
26.What drugs are antithrombins: UFH, LMWH, and Fondaparinux
27.AT MOA: Bind AT cause a conformational change that increases ATs
activity
28.What are the thrombin inhibitors (not AT): UFH/ LMWH - indirect
thrombin inhibitor
Argatroban/ Dabigatran - direct thrombin inhibitors
29.Which DTI is PO and which is IV: Dabigatran - PO
Argatroben - IV
30.What drugs target Xa:
UFH LMWH
2/
20
, NPX Complete: Anticoagulation 1.0
Fondaparin
ux
Apixaban
3/
20
1.What are anticoagulants indicated for: Tx/Px of which disease states:
Tx/Px: VTE
Tx: ACS
Px: STK 2'2 AF
2.IV anticoags are used mainly for: Tx: ACS
Tx/ Px: of VTE
3.PO anticoags are used mainly for: Tx/ Px: of VTE
Px: STK 2'2 AF
4.What activates the coagulation cascade: Blood vessel
injury Blood stasis
Pro-thrombic conditions
5.What is blood stasis: Stopping or slowing down of blood
6.What do all anticoagulants essentially inhibit the formation of: They
inhibit the formation of fibrin
7.How does the cascade work starting with Factor Xa: Xa cleaves
prothrombin into thrombin
Thrombin cleaves fibrinogen into fibrin which forms a clot
8.Which drugs increase the risk of bleeding: NSAIDs, SSRI, SNRI
9. What drugs increase clotting risk: Estrogen and SERMs
10.Heparin-induced thrombocytopenia (HIT):
11.What is HIT: An immune mediated (IgG) drug rxn seen with UFH/
LMWH A prothrombic state
Note: Antibodies form against heparin bound platelets
12.How is HIT assessed: 4Ts Score:
Thrombocytopenia, Time, Thrombosis, oTher
13.What is Thrombocytopenia: An unexplained drop in platelets (>50%)
from BL
1/
20
, NPX Complete: Anticoagulation 1.0
14.Time: Platelet drop within 5-10 days or
Within hours in patients given heparin in the last 3 months
15.Thrombosis: Newly suspected or confirmed thrombosis which are
necrotizing/ not necrotizing
16.What to do if HIT is suspected/ confirmed: STOP UFH/ LMWH and
Warfarin ( give vitamin K)
17.Why is warfarin d/c in HIT: Warfarin + low PLT = gangrene and
necrosis
18.When should warfarin be restarted: When the patients PLT recover to
>150,000
19.What dose should warfarin be initiated at: A low dose 5 mg and
overlap for at least 5 days with the INR WNL for 24h
20.When is Bivalirudin given: Cardiac surgery or PCI in patients with a Hx
of HIT
21.What is Bivalirudin: Direct thrombin inhibitor
22.What drugs are used to tx HIT: Rapid acting non-heparin
anticoagulants Argatroban + Bivarudin (Angiomax)
Fondaparinux (off label)
23.Drugs General:
24.What is antithrombin (AT): An endogenous anticoagulant
25.What does it do: Inactivates thrombin (factor IIa) and other
proteases (Xa) involved in clotting
26.What drugs are antithrombins: UFH, LMWH, and Fondaparinux
27.AT MOA: Bind AT cause a conformational change that increases ATs
activity
28.What are the thrombin inhibitors (not AT): UFH/ LMWH - indirect
thrombin inhibitor
Argatroban/ Dabigatran - direct thrombin inhibitors
29.Which DTI is PO and which is IV: Dabigatran - PO
Argatroben - IV
30.What drugs target Xa:
UFH LMWH
2/
20
, NPX Complete: Anticoagulation 1.0
Fondaparin
ux
Apixaban
3/
20
