Anticoagulation Drugs Cheat Sheet

The drugs used in clotting and bleeding disorders fall into 2 major groups:

(1) drugs used to decrease clotting or dissolve clots already present in patients at risk for vascular occlusion and

(2) drugs used to increase clotting in patients with clotting deficiencies. The first group, the anticlotting drugs, includes some of the most commonly used drugs in the United States. Anticlotting drugs are used in the treatment and prevention of myocardial infarction and other acute coronary syndromes, atrial fibrillation, ischemic stroke, and deep vein thrombosis (DVT). Within the anticlotting group, the anticoagulant and thrombolytic drugs are effective in treatment of both venous and arterial thrombosis, whereas antiplatelet drugs are used primarily for treatment of arterial disease.

DRUG SUMMARY TABLE: Drugs Used for Anticoagulation & for Bleeding Disorders

Anti-coagulation Drugs
Subclass
Mechanism
of Action
Clinical Applications
Pharmacokinetics
Toxicities, Drug
Interactions
Anticoagulants
Heparins
Unfractionated
heparin
Complexes
with 
antithrombin
III

irreversibly inactivates 
the
coagulation factors 
thrombin and factor Xa
Venous thrombosis,
pulmonary embolism,
myocardial infarction,
unstable angina, adjuvant to percutaneous coronary intervention
(PCI) and 
thrombolytics
Parenteral
administration
Bleeding
(monitor with
aPTT, protamine is reversal agent)
•thrombocytopenia
• osteoporosis with chronic use
Direct factor
X inhibitors
Rivaroxaban
Binds to the active site of factor Xa and inhibits its enzymatic action
Venous thrombosis,
pulmonary embolism,
prevention of stroke
in patients with atrial
fibrillation
Oral
administration

fixed dose no routine
monitoring
(factor Xa test)
Bleeding
• no specific
reversal agent
Direct
thrombin inhibitors
Lepirudin and dabigatran
Binds to thrombin’s
active
site and inhibits its enzymatic action
Anticoagulation in
patients with
heparin-induced
thrombocytopenia
(HIT)
Lepirudin: IV
administration
Dabigatran:
oral administration
Both:
Bleeding (monitor
with aPTT)
Lepirudin:
anaphylactic
reactions
Coumadin
anticoagulant
Warfarin
Inhibits
vitamin K poxide
reductase
and thereby
interferes
with production
of
functional vitamin
K-dependent
clotting and
anticlotting
factors
Venous
thrombosis,
pulmonary
embolism,
prevention
of
thromboembolic
complications
of atrial
fibrillation
or cardiac valve
replacement
Oral
administration

delayed onset and
offset
of anticoagulant
activity
• many drug
interactions
Bleeding
(monitor with
PT,
vitamin K1 is a reversal
agent)
• thrombosis early
in
therapy due to protein C
deficiency
• teratogen
Thrombolyticdrugs
Alteplase,
recombinant
human tissue
plasminogen
activator
(t-PA)
Converts
plasminogen to
plasmin,
which degrades
the
fibrin in thrombi
Coronary
artery
thrombosis,
ischemic
stroke,
pulmonary
embolism
Parenteral
administration
Bleeding,
especially cerebral
hemorrhage

 

anticouglation table 2

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