Anticoagulants: Classification, Monitoring, and Pharmacological Profile

Anticoagulant: It also includes:

Parenteral & Oral Agents, INR Monitoring, Mechanism, Indications and Side Effects

Classification of Anticoagulants

Heading: Classification of Anticoagulants

Parenteral Anticoagulants

Unfractionated Heparin (UFH)
Low Molecular Weight Heparins (e.g., Enoxaparin)
Protamine Sulphate (antidote)
Danaparoid

Oral Anticoagulants

Vitamin K Antagonists: Warfarin, Acenocoumarol
Non-Vitamin K Oral Anticoagulants (NOACs): not covered here

Monitoring Anticoagulant Therapy

Heading: Monitoring Warfarin: INR (International Normalized Ratio)

INR is used to standardize PT (Prothrombin Time)
Therapeutic range:

Most indications: INR 2.0–3.0
Mechanical heart valves: INR 2.5–3.5

Requires regular blood monitoring due to variability in effect

Heparin

Mechanism: Enhances antithrombin III → inhibits thrombin (IIa) and Xa
Indications: DVT, PE, MI, during dialysis
Adverse Effects: Bleeding, Heparin-Induced Thrombocytopenia (HIT)
Contraindications: Active bleeding, history of HIT
Drug Interactions: Other anticoagulants/antiplatelets increase bleeding risk

Low Molecular Weight Heparin (LMWH)

Examples: Enoxaparin, Dalteparin
Mechanism: Inhibits Factor Xa > IIa
Indications: DVT prophylaxis, PE, unstable angina
Adverse Effects: Less HIT than UFH, bleeding
Contraindications: Renal failure, active bleeding
Drug Interactions: NSAIDs, other anticoagulants

Protamine Sulphate

Mechanism: Combines with heparin to neutralize it
Indication: Heparin overdose
Adverse Effects: Allergic reactions, hypotension, bradycardia
Contraindications: Hypersensitivity to fish or protamine
Drug Interactions: None significant

Danaparoid

Mechanism: Inhibits factor Xa via heparinoid activity
Indication: Alternative anticoagulant in HIT
Adverse Effects: Bleeding, rare allergic reactions
Contraindications: Severe bleeding, sulfite allergy
Drug Interactions: Additive bleeding risk with other anticoagulants

Acenocoumarol

Mechanism: Vitamin K antagonist → inhibits synthesis of II, VII, IX, X
Indications: Atrial fibrillation, DVT, mechanical valves
Adverse Effects: Bleeding, skin necrosis, teratogenic
Contraindications: Pregnancy, liver disease, bleeding disorders
Drug Interactions: Many – esp. antibiotics, NSAIDs, food (vitamin K-rich)

Phenindione

Mechanism: Similar to warfarin; inhibits vitamin K-dependent clotting factors
Indications: Same as warfarin (less commonly used)
Adverse Effects: Bleeding, hypersensitivity, agranulocytosis
Contraindications: Similar to warfarin
Drug Interactions: Extensive, similar to warfarin

Presentation for Anticoagulants: Classification, Monitoring, and Pharmacological Profile

END OF THE CHAPTER

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