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Anticoagulant clinical summary
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Summary of 2 pages for the course pharmacy at UBir (Lecture notes)
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Anticoagulants/ anti platelets/ Anti ThromboticsDefinitions:
Anti-coagulant: a drug that prevents blood from clotting
Anti-thrombotic: a drug that prevents thrombus formation
Thrombolytic (clot buster): a drug that dissolves blood clots
Anticoagulants:
https://cks.nice.org.uk/topics/anticoagulation-oral/ [NICE guideline ref]
There are two main types of oral anticoagulants: vitamin K antagonists (VKAs) and direct
oral anticoagulants (DOACs).
Warfarin, the most commonly used VKA, is a coumarin derivative that acts by
inhibiting vitamin K dependent clotting factors (II, VII, IX, X) in addition to the
anticoagulant proteins C and S. Warfarin has been used for decades as an
anticoagulant.
DOACS (apixaban, dabigatran, edoxaban, and rivaroxaban) are anticoagulants with a
novel mode of action: apixaban, edoxaban, and rivaroxaban are direct and reversible
inhibitors of factor Xa (inhibition of factor Xa prevents thrombin generation and
thrombus development). Dabigatran is a reversible inhibitor of free thrombin, fibrin-
bound thrombin, and thrombin-induced platelet aggregation.
Licensed indications:
https://cks.nice.org.uk/topics/anticoagulation-oral/background-information/licensed-
indications/
Management:
CHADVASC tool used to calculate risk of having a stroke
https://chadsvasc.org/
Patients with AF who are low-risk male pts with score of 0 and female pts with a
score of 1 (age <65 and lone AF) do not require antithrombotic therapy.
Is score >2 must start anticoagulation therapy.
HAS-BLED tool used to predict risk of bleeding in people who are on anticoagulation
therapy
Score of 3 or more suggests increased 1 year bleed risk on anticoagulation need
caution or more regular review.
List of anti-coagulants:
Heparin (parenteral anticoagulants)
• Unfractionated Heparin (UFH)
• Given IV or subcutaneously with immediate anticoagulant
properties
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