Now let's talk about antithrombotic agents.
Why would these be high risk medications?
Well, we use antithrombotics with patients
who are at risk for developing new or additional blood clots.
So if I have a clot, I don't want any more to form but if I have a clot,
I've already proven you I'm pretty good at doing it, right?
So that's why we put them on antithrombotic agent.
We're talking about that clot that I have not getting any bigger and new clots not forming.
If I'm so -- have a history of an MI or stroke,
I've also proven to you in the past I was really good at making clots
so I might be on this medication over a long period of time.
So we use this for patients who've had a heart attack, a stroke,
they've had a DVT, a deep vein thrombosis, or a pulmonary embolus.
They may be on antithrombotic agents for a long period of time.
Now we got a picture there. It's kinda cool.
It shows you how a clot is supposed to form
but people that are making clots in inappropriate places
like, you know, in your heart and in your brain or in deep in your calf,
this is when it kinda goes wrong and that's why we put them on this type of medications.
Okay, let's look at 5 categories. I'm gonna give you examples in 5 categories.
The high risk with these medications remember is risk of hemorrhage.
So anticoagulants, well, here's an old school drug.
Warfarin or Coumadin, patients can be on this for lifetimes
or a relatively short period of time depending on their needs
but warfarin or Coumadin is an example.
Low molecular weight heparin, those are the ones
that patients have to give to themselves sub-Q in their abdomen
if they're going home with it or you have unfractionated heparin,
that's the old school heparin that we give IV or you can also give sub-Q.
Now there's direct oral anticoagulants factor Xa inhibitors.
These guys are really newer to the scene.
They do some super cool things, same risk, or at risk for bleeding.
Direct thrombin inhibitors, glycoprotein with our roman numerals there inhibitors.
You see that one and thrombolytics.
Now remember, the rest of these medications are gonna hopefully stop the clots
you have from getting bigger or new ones from forming.
Thrombolytics, put a star by that category.
These are the ones that are clot busters.
They will break up any clot throughout your body.
So I've had some really dramatic patients when they've received a thrombolytic
that we did our pre-emptive checklist, we did everything we could
to make sure that we had tried to eliminate all risk factors
and they still had a really negative outcome
because they ended up bleeding out in their head and honestly, not making it.
When these work, they're fantastic but they do have a high risk
that has to be explained to the patients and families
so they can make the choice on whether they want to try this medication or not.
Also with thrombolytics, they have to be given with a small window of time
after symptoms have started.
So before these, while they do have risk, that 5th category of thrombolytics,
when it works well, it is incredible.
When it doesn't and it has that effect of hemorrhage,
depending on the location of that hemorrhage and the intensity,
it can really have a negative outcome.