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Anticoagulant Drugs

CORRECTION - Spoken mistake in the first minute of the video -- The oldest drug on this video is heparin, NOT Warfarin. I created this presentation with Google Slides. Image were created or taken from Wikimedia Commons I created this video with the YouTube Video Editor. ADDITIONAL TAGS Anticoagulant Drugs Commonly used blood thinners for treating venous thromboses Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Warfarin Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Inhibits Vitamin K regeneration Therefore, inhibits Vit K-dependant factors Coag factors II, VII, IX, and X and protein C and S Warfarin Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Vitamin K Vit K epoxide reductase Vitamin K epoxide Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Warfarin Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Inhibits Vitamin K regeneration Therefore, inhibits Vit K-dependant factors Coag factors II, VII, IX, and X and protein C and S Requires bridging with use Warfarin blocks II, VII, IX, X, C, and S C, a coagulation cascade inhibitor, runs out first So if used alone, Warfarin has a COAGULATIVE effect at first Use with other coagulant for first five days Otherwise, skin necrosis Can be taken orally, effects require a few days NOT compatible with pregnancy Heparin Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Very negatively charged carbohydrate Polysaccharide with sulfate groups Binds to antithrombin Inhibits thrombin (IIa) and coag factor Xa Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Heparin Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Very negatively charged carbohydrate Polysaccharide with sulfate groups Binds to antithrombin Inhibits thrombin (IIa) and coag factor Xa Heparin must be 5 sugars long to bind AT and 18 sugars to inhibit thrombin in the heparin-AT complex Heparin monitored with Anti-Xa levels Coag factor Xa activity measured based on decrease in rate of: X → Xa Antidote is positively-charged protamine sulfate Administered subcutaneously, incurs effects immediately Enoxaparin (Low Molecular Weight Heparin) Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Polymers approximately one third the size of big Heparin Cannot complex with antithrombin to inhibit thrombin Enoxaparin is not the required 18 sugars long Affects coag factor Xa, as measured with Anti-Xa test Improved effects against VTE associated with cancer Fondaparinux (“tiny Heparin†) Pentasaccharide portion of heparin binds to antithrombin Cannot complex with antithrombin to inhibit thrombin Affects coag factor Xa, as measured with Anti-Xa test Synthetically made, unlike others that are animal extracts Does not induce HIT, unlike the others New Oral Anticoagulants Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban NOACs cause fewer intracranial bleeds NOT used in patients with mechanical heart valves Rivaroxaban and Apixaban Inhibit factor Xa Metabolized in the liver Dabigatran Direct thrombin inhibitor Cleared through kidneys Argatroban Warfarin Heparin Enoxaparin (LMWH) Fondaparinux (tiny Heparin) NOACs Argatroban Direct thrombin inhibitor No need for antithrombin Therefore it inhibits all three coagulation tests TT, PT, and PTT Used in cases of HIT Metabolized in the liver