So anticoagulants treat thrombosis in veins.
Let me say that again, anticoagulant we use those to treat thrombosis in veins -
so we’ve got the heparin activities of antithrombin, we use low molecular weight heparin,
that’s really cool stuff, that’s the one we’ll use predominantly.
So for heparin, we use it because it activates antithrombin.
So when I first had my giant cough, we were dealing with, I was on heparin, low molecular weight heparin.
We also have unfractionated heparin, but it’s a little problematic it requires a lot more blood work for safety,
so predominantly, what you’ll see in your practice is low molecular weight heparin.
We were really excited when this one came out because it’s just as effective as unfractionated heparin
and we didn’t have to do as much testing, not as many risk factors.
Now the last ones are really cool sounding name -- fondaparinux, I like that,
or you can say fondaparinux, whatever sounds better to you,
but we’re looking at going after antithrombin and that’s what heparin does.
These are three forms of heparin in these first column.
Now vitamin K antagonist. Vitamin K is involved in blood clotting, this blocks that process.
The name of that drug is warfarin.
I was started on low molecular weight heparin in the hospital,
then when I went home I stayed on the low molecular weight heparin until the warfarin kicked in.
I was on both at the same time -- low molecular weight heparin and warfarin in the hospital,
but it takes a while for warfarin to kick in which is why I went home on both ‘til my lab values
said that the warfarin had kicked in enough that my PT INR was therapeutic.
And the third category is direct thrombin inhibitors and that’s bivalirudin.
Okay so take a look at the slide and how we have it organized for you to remember this in your mind.
These are anticoagulants, right? They treat what? Thrombosis in veins, good.
So make sure you have that established.
Now look at the next level; we’ve got three options -- heparin, vitamin K antagonist and direct thrombin inhibitors.
So if I have a patient who has a thrombus, who has a clot, we’re looking at one of these three medications.
I already gave you a little tip on this, right?
I told you when I was in the hospital immediately they started me on heparin, low molecular weight heparin
which means I got shots in my abdomen regularly throughout the day and let me just tell you,
someone who’s experienced it, for me, they burn like fire. I didn’t mind the sticking part,
but when they put the medicine in, it was like, yeah, and you’ll have bruises all over your abdomen.
You can tell easily where you’ve been injected.
Now they start the warfarin a few days before I went home in the hospital
and I went home on both of these -- low molecular weight and Coumadin.
Why do I keep telling you my story, not because you need to know my story,
but you need to be prepared for your patients in the hospital.
They’ve had a clot, they will likely start on low molecular weight heparin
and then if we’re gonna discharged him on this therapy, they’ll start oral medications, warfarin.
Low molecular weight heparin, subq injection; warfarin, oral pill.
You can be on both at the same time because look at those grey boxes, they work differently
and they have different lab work, so pause for just a minute, go back to the beginning of this presentation,
remember what type of lab work that we do -- just do it in your mind.
For vitamin K antagonist and warfarin, we use PT INR for lab work.
For the heparin, we’ll either use the APTT or the Xa levels. So just draw yourself a note in that.
Okay, for direct thrombin inhibitors, we’ll also talk about them
but the first two are the most common that you’ll see in your practice.
Now antiplatelet groups -- these are drugs that treat thrombosis in arteries.
Okay, so we just talked about three groups of drugs that we use to treat clots in your veins.
Without looking back, can you remember those three categories?
Okay, good. That pause and reflect and review, that’s gonna help you remember things.
So those three medications we use for veins.
Now we’re talking about arteries. Aspirin is a pretty cheap medication, right?
We can give it in some fancy forms but it’s a COX inhibitor.
It’s an antiplatelet and we use this for an arterial problem.
Now this one, look at the name of that one -- P2Y12ADP receptor antagonist -- that will also block that platelet coming together.
And finally here’s another one GP IIb/IIa receptor antagonist.
We go after these receptors to help stop those platelets from grouping together.
So when it comes to antiplatelets, they’re in arteries. Huh? Good, huh!
Antiplatelets are in arteries but, oh, wait a minute.
The other one’s anticoagulants in veins, so that doesn’t help us as much,
so you’re gonna have to work a little bit harder to make sure you remember -
antiplatelet drugs we go after things like aspirin and these really long name receptor antagonist.
For veins, we look back at the three groups of drugs that we use -- heparin, vitamin K antagonist and direct thrombin inhibitors.
So we’re talking about anticoagulants.
They reduce the formation of that fibrin, remember?
Clotting factors cause fibrin strands to stick together and they seal the wound from the inside.
Now anticoagulants have two major mechanisms of action.
The first one is they inhibit the synthesis of clotting factors, factor X and thrombin.
So anticoagulants first mechanism of action?
They stop the synthesis or the making of clotting factors, factor x and thrombin.
Their second mechanism of action is they inhibit the activity of clotting factors, factor Xa or thrombin or both.
Okay, now that seems like a mouthful to try to remember all that, so just remember,
anticoagulants either make you have less clotting factors or they really get in the way of those clotting factors working and causing clots.
Now what do you need to write next to those two bullet points to make sure that makes sense to you?
So put that into your words, they both inhibit the making of and inhibit the activity of clotting factors
and that is really good enough for you to get the basic idea of anticoagulants.