Questions: Coagulant Drugs

by Pravin Shukle, MD

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    Let's try a question in anticoagulation. The first question. The following medication will act upon thrombin in the serum and thrombin enmeshed within clots. Take a look at these choices and try to come up with a good answer. So the answer is A, bivalirudin. Now when we talk about bivalirudin, remember that the heparins in general like enoxaparin, unfractionated heparins are generally large molecules, and they don't go inside the clot. They do not work on the thrombin that is already enmeshed within the clot. Protamine is a base that inactivates heparin and not thrombin, so that's not the choice. Fondaparinux is a pentamer moiety that is cleaved from heparin. It does not affect the thrombin that is already enmeshed within the clot. And then of course the bivalirudin is coming from the medicinal leech, it's a direct thrombin inhibitor, and that acts on enmeshed thrombin. So, that's why A is the correct answer. Here's a great question on coagulation. A patient with a history of atrial fibrillation arrives in the emergency room with an acute GI bleed and a nosebleed. He has a medical bracelet that says "anticoagulants". The spouse says that the patient was not required to have monthly blood monitoring. The pharmacy dispensed dabigatran in the last month. What would the most appropriate antidote be? Have a look at these choices, and tell me which one is the most appropriate antidote. So the answer is E, idarucizumab. So idarucizumab is a monoclonal antibody. It is the new way to treat overdose from dabigatran. This is a new treatment. We did not have an antidote until just very recently. Before we used to use octoplex or biraplex. This is an important thing for you to remember, because when you're using old exams to study from, the old...

    About the Lecture

    The lecture Questions: Coagulant Drugs by Pravin Shukle, MD is from the course Pharmacology of Blood Coagulation. It contains the following chapters:

    • Question 1: Pharmacology of Coagulation
    • Case Study 1: Pharmacology of Coagulation
    • Question 2: Pharmacology of Coagulation

    Author of lecture Questions: Coagulant Drugs

     Pravin Shukle, MD

    Pravin Shukle, MD

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