Warfarin (coumadin)

Heparan

LMWH

danapariod

fondaparinux

LMWH's

Enoxaparin

Daltaparin

Tinzaparin

Like vit K  -> inhibit vit k factors

2, 7, 9 , 10

Inhibit formation of pro C and S (factor 5 and 8)

LT-> against thromboembolic d/o and heart valves

what should be monitored in pts

on warfarin

PT and INR

INR in heart valves/embolism-> 2-3

INR recommended ->3-4.5

what should the INR be for a pt on warfarin

w/ heart valves/embolism

2-3

oral

p450 met

 excr. urin

BLEEDING ->

fatal hemorrhage and malformation

TERATOGENIC -> NO PREGO

LOTS!

narrow TI

certain foods interfere w/ control

potentiates activity of AT III

(endogenous anticoagulant)

acute thromboembolic d/o

prophylactive prevention of clots

PK heparin

BLEEDING

HIT

1. mild -> reversible,

interaction bw platelets and heparin

2. serious -> immunoglobulin platelet inactivation

protamine sulfate

dose based on amt of active heparin in body

CHECK aPPT 2-4 hrs after admin

Absolute->serious active bleeding

-intracranial

-CNS/eye surg

-malignant HTN

Relative -> active GI bleed

-major surg

-severe HTN

-threatened abortion

inactivate factor 10

SQ

NO aPPT

prevent thromboembolism assoc w/ surg

(1x before and 5-10 days after)

prevent ischemic events from unstable angina

synthetic pentasaccharide

factor 10 inhibitor