The Coagulation Cascade
It's obvious what factor these drugs work on, just look at the "xa" in 2 of their names!
Direct oral anticoagulants (DOACs)
This is the dose of Xarelto we would give for 21 days for VTE treatment. Don't forget to follow it with 20 mg daily after!
15 mg PO BID
This drug is dosed twice daily for every indication and has 3 criteria (2 of which must be met) to dose adjust in afib
Eliquis
This is the molecule that heparin can bind to on platelets
Protein Factor 4 (PF4)
Doses of Rivaroxaban greater than or equal to this amount should be taken with food for best absorption
15 mg
The conversion of this factor to its active form is the start of the common pathway
X
This medication is monitored and adjusted based on INR
Warfarin
This drug's efficacy can be altered by green, leafy vegetables (among other things)
Coumadin
This is how we treat a patient with HIT
Anticoagulation
This is the typical INR goa for warfarin patients with a mechanical aortic valve
2 to 3
This is another name for factor IIa, which is the active form of prothrombin
Thrombin
The dosing of these two drugs are based only on aPTT
Bivalirudin and Argatroban
This drug must be dispensed in its original packaging to protect from moisture
Pradaxa
This is the effect of heparin binding to PF4
Antibody formation and platelet activation
This is the SC injection of choice for VTE prophylaxis in patients with CrCl <30 mL/min
Heparin
These are the factors that are inhibited by warfarin
II, VII, IX, and X
The dosing of Lovenox for VTE treatment can be given two different ways: ___ mg/kg q12h or ___ mg/kg q24h
1 and 1.5
In addition to heparin, this medication should also be avoided in patients with HIT
Lovenox
This is the timing of platelet fall and percentage of platelet fall we would expect for confirmed HIT
50% between days 5 to 10
This is the lab that is most accurate when monitoring heparin (provided you haven't had a DOAC in the previous 72 hours)
Anti-Xa
This drug is the synthetic version of heparin, but has a different target
Fondaparinux (Arixtra)
This is the only indication for which Eliquis is dose adjusted
Atrial fibrillation
This SC drug is dosed based on weight and can be given to patients with a history of HIT for VTE prophylaxis
Arixtra
This might be another cause for thrombocytopenia in a patient with suspected HIT
- Blood or bone marrow cancers
- Anemia
- Chemotherapy
- Cirrhosis
- Antibiotics
These are the 3 criteria we look at to determine if Eliquis dose should be adjusted in afib
Age >/= 80 years, Weight >/= 60 kg, Scr >/= 1.5 mg/dL