anticoagulants

(anticoagulants)

Warfarin

Uses:

* Afib
* Mechanical valves
* DVT/PE


Overdose:

* Bleeding to death: give FFP with will immediately help, and give Vit K (takes a couple days to work)
* Just have an elevated INR (no active bleeding):
* Hold coumadin
* Give Vit k if INR really high


Good:

* Oral (means no annoying shots)
* Cheap


Bad:

* Takes a few days to reach a therapeutic level
* Hard to reverse
* Hard to regulate


Ugly:

* Warfarin skin necrosis (pro-clot situation, happens because protein c and s go
* away first leaving factors 10, 9, 7, and 2 unopposed)



Heparin

Uses:

* DVT/PE in hospital
* AMI
* Non-hemorrhagic stroke
* DIC
* Prophylaxis in hospital


Overdose:

* Bleeding to death: protamine sulfate
* Elevated PTT: hold heparin
* Good:
* Quick and cheap
* Easy to monitor
* Easy to reverse
* Can give to preggos


Bad:

* IV/Subcut only
* Have to give often (you get an subcutaneous injection every 8 hours)
* Variable response to same dose


Ugly:

* HIT (platelets drop 50% in a few days or get less than 50,000, history of heparin exposure (heparin coated catheters, heparin flushes, put a sign above their bed saying "NO HEPARIN PRODUCTS")
* Die from thrombosis (arterial or wacky venous thrombosis)
* Treat HIT by withholding ALL heparin products, argatroban, lepirudin. Can never give enoxaparin if already have HIT because it can cause HIT 5% of time.


Enoxaparin

Uses:

* AMI
* DVT/PE
* Preggos w/ DVT


OD:

* Active bleeding give FFP
* Hold enoxaparin


Good:

* Can give to preggos
* Longer half life
* Don't need to monitor (for a given dose per weight you will get a known result)
* Less incidence of HIT


Bad:

* $$$$$
* Subcut only
* Still can cause HIT
* Adjust with renal failure