Anticoagulant Drugs

CORRECTION - Spoken mistake in the first minute of the video -- The oldest drug on this video is heparin, NOT Warfarin.

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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

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