NCLEX RN Practice Question # 587

NCLEX Examination.

Practice Question # 587.




Heparin Therapy

Direct thrombin inhibitors

  • These agents are able to inhibit thrombin activity by interacting with the catalytic or substrate recognition site of the protease without the need for AT-III.
  • Lepirudin (Refl udan®) is a 65 amino acid recombinant derivative of hirudin, the anticoagulant found in the saliva of the medicinal leech. Bivalirudin (Angiomax®) is a synthetic 20 amino acid derivative of hirudin.
  • Th ese agents are administered parenterally to inhibit thrombin activity and reduce the formation of thrombi. Argatroban is also a parenterally administered, direct thrombin inhibitor, and all three of these agents are used to treat HIT. Bivalirudin is also used to prevent thrombosis aft er coronary angioplasty procedure. Dabigatran (Pradaxa®) is the fi rst orally active direct thrombin inhibitor and is used to prevent stroke in patients with atrial fi brillation.
  • Adverse eff ects to these agents are usually bleeding, but dabigatran is also associated with GI disturbances such as esophageal refl ux, gastric bleeding, and abdominal pain.

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