Parental Anticoagulants

Drug:  heparin (unfranctionated)

ALWAYS IN UNITS

• Action:  quickly suppresses coagulation / inactivates thrombin & other clotting factors
• Use:  PE (pulmanary emboli); evolving stroke; massive     DVT; DIC (deceminated intravascular coagulation: very massive through out body); prophylaxis for VENOUS thrombosis
• Effects: Stage II of hemostasis - suppression of fibrin formation
• Adverse Effects: Hemorrhage; thrombocytopenia (platelet count to low); heparin induced thrombocytopenia (platelet count to low, but they clot more.  Have to take them off the drug and try another one)
• Drug:Drug: ASA; ibuprofen
• Warning: Hemophilias; peptic ulcer disease; severe HTN; severe liver/kidney disease.
• Overdose: antidote is protamine sulfate, fast acting, binds to heparin

Direct thrombin inhibitors

Drug: warfarin (Coumadin)

Oral Only

Action: (does not disolve the clot) suppression of coagulation by antagonist of Vit. K

Use: long-term prophylaxis of thrombosis VENOUS; PE; prosthetic heart valves and recurrent TIA's

Effect:  decrease in thrombosis formation

Adverse Effects: hemorrhage; fetal homorrhage & teratogenesis - category X

Drug:Drug: any drug that interfers with coagulation, high risk of hemorrhage; ASA acetaminophen, cimetidine(Tagament & disulfiram (Antabuse)

Warning: not for pts w/ high risk of bleeding

Parenteral Anticoagulatns

Low-molecular weight

Drugs:  enoxaparin (lovenox) &

dalteparin (Fragmin)

ALWAYS IN UNITS

• Use: prophylaxis of DVT > abd surg, hip/knee replacement; DVT w/ or w/o PE; ischemic complications from unstable angina & MI
• Effects: Similar to heparin
• Adverse Effects: Severe neurological injuries  permanent paralysis do to LP or spinal/epidural (the small mol. can get into the spinal cord and go to the brain)