##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!################################
Anticoagulants_Edapts.pdf - converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- converted.pdfAnticoagulants_Edapts.pdf - conver
12/23/23, 6:13 PM Anticoagulants Edapts
Introduction to Anticoagulants
Recall that coagulation modifier drugs include a diverse group of
subclasses or categories, each performing a specified task in the
process of hemostasis: preventing or promoting clot formation,
breaking down a preformed clot, or reversing the action of
anticoagulants. These subclasses include anticoagulants,
antiplatelets, thrombolytics, antifibrinolytics, and reversal drugs.
For this module, we will be focusing on Anticoagulants and factors
specific to their function in hemostasis. We will discuss its
indications or for use, safety considerations, and common drugs
used in this subclass.
Enoxaparin is a type of heparin known as low-molecular-weight
heparins (LMWHs)
Clopidogrel is an antiplatelet drug
Warfarin is an anticoagulant, but is not a heparin
Rivaroxaban is a selective factor Xa inhibitor (an anticoagulant
but not a heparin)
Anticoagulants are also known as antithrombotic drugs because
they (in general) prevent and treat thrombosis (clot formation), and
prevent embolus (dislodging and mobilization of a thrombus that
has formed on the wall of a blood vessel). However, anticoagulants
do not directly affect/dissolve thrombi that have already formed.
Coumarins work to prevent thrombus formation within the
coagulation cascade system by inhibiting vitamin K-dependent
clotting factors II, VII, IX, and X by inhibiting the production of the
vitamin K they need. This ultimately prevents the formation of clots
(thrombi). They do not directly breakdown clots, impact platelet
function, or decrease the viscosity of blood.
About Anticoagulants
Recall that Anticoagulants are a type of coagulation modifier drug.
Anticoagulants include heparins, low–molecular-weight heparins
(LMWHs), direct thrombin inhibitors, and selective factor Xa
about:blank 1/20
##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!######################################
Page 1 of 20Anticoagulants_Edapts.pdf - converted.pdfAnticoagulants_Edapts.pdf
- converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- conver
,##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!################################
Anticoagulants_Edapts.pdf - converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- converted.pdfAnticoagulants_Edapts.pdf - conver
12/23/23, 6:13 PM Anticoagulants Edapts
inhibitors. The role of anticoagulants within the coagulation cascade
system is to prevent clot formation by inhibiting particular
clotting factors.
Mechanism of action – specific actions vary with each type of
anticoagulant
Anticoagulants are also known as antithrombotic drugs
because they (in general):
decrease coagulability and are therefore used to
prophylactically
prevent and treats thrombosis (clot formation)
prevent embolus (dislodging and mobilization of a
thrombus that has formed on the wall of a blood
vessels)
are used to prevent and treat thromboembolic
events (sometimes in combination with other CMDs):
prevent an MI, stroke, pulmonary embolism,
and deep vein thrombosis (DVT)
an embolus that lodges in a coronary artery,
brain vessel, lung, or leg vein
do not directly affect/dissolve thrombi that are already
formed
all anticoagulants have a function at different points in
the coagulation cascade system
Anticoagulant Indications for Use - prevention of thrombus formation
in which it is likely to occur
MI
Unstable angina
Atrial fibrillation
Indwelling devices, such as mechanical heart valves
When blood flow may slow and blood may pool such as with
major orthopedic surgery, prolonged immobilization and
hospitalization, or long plane rides
Prevention and treatment of DVT or PE (except
betrixaban, which is only approved for prophylaxis at this
time)
Bleeding is the main complication of anticoagulation therapy,
and the risk increases with increasing dosages. Such bleeding
may be localized or systemic.
about:blank 2/20
##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!######################################
Page 2 of 20Anticoagulants_Edapts.pdf - converted.pdfAnticoagulants_Edapts.pdf
- converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- conver
,##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!################################
Anticoagulants_Edapts.pdf - converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- converted.pdfAnticoagulants_Edapts.pdf - conver
12/23/23, 6:13 PM Anticoagulants Edapts
Safety Considerations for
Anticoagulants
Recall that drugs which affect coagulation are among the most
dangerous drugs used today, and numerous factors can affect their
action. They are also among those most commonly associated with
adverse drug reactions. In general, the risk with these medications
is that they will overshoot their intended purpose and cause an
excess of the opposite process. Anticoagulants prevent clot
formation in order to stop bleeding. However, if it does not achieve
the intended hemostasis, it could have the unintended consequence
of excessive bleeding. Careful use and monitoring with this drug
class can help ensure these medications result in hemostasis and
the intended therapeutic effects.
Localized or systemic bleeding is the main complication of all
anticoagulation therapy and the risk increases with increasing
dosages. Some of these medications pose more of risk for bleeding
than others. Anticoagulants are contraindicated in the following
situations:
Acute Bleeding
Patients who are actively bleeding or are at high risk for an acute
bleeding situation such as with underlying coagulation disorders,
ulcer disease, malignancy, or recent surgery in which bleeding was
an issue.
Pregnancy
In pregnancy, anticoagulants are used cautiously (pregnancy
categories B or C) although some are strongly contraindicated
pregnancy (warfarin).
Epidural Hematoma
Patients with an indwelling epidural catheter are at risk for
developing an epidural hematoma (localized bleeding outside of
blood vessels).
Anticoagulant Adverse Effects are common and serious, sometimes
lethal, with these drugs.
Bleeding, localized or systemic – the higher the dose, the
higher the risk
GI upset – nausea, vomiting, abdominal cramps
about:blank 3/20
##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!######################################
Page 3 of 20Anticoagulants_Edapts.pdf - converted.pdfAnticoagulants_Edapts.pdf
- converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- conver
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!################################
Anticoagulants_Edapts.pdf - converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- converted.pdfAnticoagulants_Edapts.pdf - conver
12/23/23, 6:13 PM Anticoagulants Edapts
Introduction to Anticoagulants
Recall that coagulation modifier drugs include a diverse group of
subclasses or categories, each performing a specified task in the
process of hemostasis: preventing or promoting clot formation,
breaking down a preformed clot, or reversing the action of
anticoagulants. These subclasses include anticoagulants,
antiplatelets, thrombolytics, antifibrinolytics, and reversal drugs.
For this module, we will be focusing on Anticoagulants and factors
specific to their function in hemostasis. We will discuss its
indications or for use, safety considerations, and common drugs
used in this subclass.
Enoxaparin is a type of heparin known as low-molecular-weight
heparins (LMWHs)
Clopidogrel is an antiplatelet drug
Warfarin is an anticoagulant, but is not a heparin
Rivaroxaban is a selective factor Xa inhibitor (an anticoagulant
but not a heparin)
Anticoagulants are also known as antithrombotic drugs because
they (in general) prevent and treat thrombosis (clot formation), and
prevent embolus (dislodging and mobilization of a thrombus that
has formed on the wall of a blood vessel). However, anticoagulants
do not directly affect/dissolve thrombi that have already formed.
Coumarins work to prevent thrombus formation within the
coagulation cascade system by inhibiting vitamin K-dependent
clotting factors II, VII, IX, and X by inhibiting the production of the
vitamin K they need. This ultimately prevents the formation of clots
(thrombi). They do not directly breakdown clots, impact platelet
function, or decrease the viscosity of blood.
About Anticoagulants
Recall that Anticoagulants are a type of coagulation modifier drug.
Anticoagulants include heparins, low–molecular-weight heparins
(LMWHs), direct thrombin inhibitors, and selective factor Xa
about:blank 1/20
##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!######################################
Page 1 of 20Anticoagulants_Edapts.pdf - converted.pdfAnticoagulants_Edapts.pdf
- converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- conver
,##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!################################
Anticoagulants_Edapts.pdf - converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- converted.pdfAnticoagulants_Edapts.pdf - conver
12/23/23, 6:13 PM Anticoagulants Edapts
inhibitors. The role of anticoagulants within the coagulation cascade
system is to prevent clot formation by inhibiting particular
clotting factors.
Mechanism of action – specific actions vary with each type of
anticoagulant
Anticoagulants are also known as antithrombotic drugs
because they (in general):
decrease coagulability and are therefore used to
prophylactically
prevent and treats thrombosis (clot formation)
prevent embolus (dislodging and mobilization of a
thrombus that has formed on the wall of a blood
vessels)
are used to prevent and treat thromboembolic
events (sometimes in combination with other CMDs):
prevent an MI, stroke, pulmonary embolism,
and deep vein thrombosis (DVT)
an embolus that lodges in a coronary artery,
brain vessel, lung, or leg vein
do not directly affect/dissolve thrombi that are already
formed
all anticoagulants have a function at different points in
the coagulation cascade system
Anticoagulant Indications for Use - prevention of thrombus formation
in which it is likely to occur
MI
Unstable angina
Atrial fibrillation
Indwelling devices, such as mechanical heart valves
When blood flow may slow and blood may pool such as with
major orthopedic surgery, prolonged immobilization and
hospitalization, or long plane rides
Prevention and treatment of DVT or PE (except
betrixaban, which is only approved for prophylaxis at this
time)
Bleeding is the main complication of anticoagulation therapy,
and the risk increases with increasing dosages. Such bleeding
may be localized or systemic.
about:blank 2/20
##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!######################################
Page 2 of 20Anticoagulants_Edapts.pdf - converted.pdfAnticoagulants_Edapts.pdf
- converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- conver
,##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!################################
Anticoagulants_Edapts.pdf - converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- converted.pdfAnticoagulants_Edapts.pdf - conver
12/23/23, 6:13 PM Anticoagulants Edapts
Safety Considerations for
Anticoagulants
Recall that drugs which affect coagulation are among the most
dangerous drugs used today, and numerous factors can affect their
action. They are also among those most commonly associated with
adverse drug reactions. In general, the risk with these medications
is that they will overshoot their intended purpose and cause an
excess of the opposite process. Anticoagulants prevent clot
formation in order to stop bleeding. However, if it does not achieve
the intended hemostasis, it could have the unintended consequence
of excessive bleeding. Careful use and monitoring with this drug
class can help ensure these medications result in hemostasis and
the intended therapeutic effects.
Localized or systemic bleeding is the main complication of all
anticoagulation therapy and the risk increases with increasing
dosages. Some of these medications pose more of risk for bleeding
than others. Anticoagulants are contraindicated in the following
situations:
Acute Bleeding
Patients who are actively bleeding or are at high risk for an acute
bleeding situation such as with underlying coagulation disorders,
ulcer disease, malignancy, or recent surgery in which bleeding was
an issue.
Pregnancy
In pregnancy, anticoagulants are used cautiously (pregnancy
categories B or C) although some are strongly contraindicated
pregnancy (warfarin).
Epidural Hematoma
Patients with an indwelling epidural catheter are at risk for
developing an epidural hematoma (localized bleeding outside of
blood vessels).
Anticoagulant Adverse Effects are common and serious, sometimes
lethal, with these drugs.
Bleeding, localized or systemic – the higher the dose, the
higher the risk
GI upset – nausea, vomiting, abdominal cramps
about:blank 3/20
##############Anticoagulants_Edapts.pdf
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!######################################
Page 3 of 20Anticoagulants_Edapts.pdf - converted.pdfAnticoagulants_Edapts.pdf
- converted.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- conver
