Anticoagulants

Contraindications to Anticoagulation

• Absolute:
  • Active bleeding
  • Severe bleeding diathesis or platelet count <20K
  • Neurosurgery, ocular surgery, or intracranial bleeding in the last 10 days
• Relative:
  • Mild-to-moderate bleeding diathesis or thrombocytopenia
  • Brain metastases
  • Recent major trauma
  • Major abdominal surgery within the past 2 days
  • GI or GU bleeding within the past 14 days
  • Endocarditis
  • Severe hypertension (>200/120mmHg) at presentation

Vitamin K Antagonist

Blocks activation of vitamin K dependent prothrombotic factors II, VII, IX, X and blocks synthesis of vitamin K dependent ANTI-thrombotic proteins C and S

• Warfarin

Heparins

Bind to and activate antithrombin, which in turns inactivates factor Xa and thrombin

• Unfractionated heparin
• Low molecular weight heparin
  • Enoxaparin (Lovenox)
  • Dalteparin

Parenteral Factor Xa Inhibitors

• Fondaparinux

Direct oral anticoagulants (DOACs)

Factor Xa Inhibitors

Inhibits Factor Xa, leading to inactivation of thrombin

• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Edoxaban

Direct Thrombin Inhibitors

Directly inhibits thrombin

• Dabigatran
• Argatroban
• Bivalirudin

See Also

• Anticoagulant reversal for life-threatening bleeds
• Antiplatelet medications
• Procedures in patients with coagulopathies