anticoags: HEPARIN

1. low molecular weight

1.1. dalteparin; enoxaparin; tinzaparin

1.2. prophylaxis AND tx for DVT and PE

1.3. enoxaparin tx ACS

1.4. predictable dose

1.4.1. no lab monitoring

1.5. longer 1/2 life

1.6. outpt tx: LMWH overlapped w/warfarin for 5 days

1.7. AE: bleeding; less thrombocytopenia than unfractionated

2. heparin derivative: heparinoid

2.1. Fondaparinux

2.2. MOA: heparin derivative; binds to antithrombin which inhibits factor Xa; indirectly inhibit conversion of prothrombin to thrombin

2.3. approved for HIT, DVT prevention, ACS; subq administration

3. Protamine sulfate; a reversal for heparin od

4. MOA: accelerates ability of antithrombin to active coag->

4.1. prevents thrombus prop by facilitating fibrinolysis BUT does not lyse existing thrombi

5. unfractionated

5.1. short half life (rapid anticoag)

5.2. tx of DVT/PE; prophylaxis for VTE; acute coronary syndrome

5.3. safe in pregnancy

5.4. variable dosing ->

5.4.1. adjust dosage according to aPTT

5.5. AE: bleeding (more c in elderly women); reversal agent is IV protamine sulfate; GI; thrombocytopenia (HIT)