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Oral Anticoagulants

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Oral anticoagulants are used on a daily basis in hospitals and outpatients.A detailed understanding about these drugs is explained in this video and also how to choose among the list .

Hello everybody welcome to my channel medicine in a minute i am a doctor and consultant of medicine and i am here to simplify medicine for you in a minute so let’s get started so the topic i have chosen for you today is oral anticoagulants there are a lot of iv anticoagulants also that is known as heparin and molecular pattern but that is a very different topic

To be discussed in detail later today i’ll be dealing with the oral anticoagulants and we have two groups in it one is the vitamin k antagonist and the other one is non-vitamin k antagonist so the vitamin k antagonist we have is the old and the tested one which has been going on for years and years is the warfarin and here non-vitamin k antagonist include direct

Trauma inhibitors and factor 10 a inhibitors direct thrombin inhibitors is only derby gatrin and the other one factor 10 inhibitors are rivaroxaban a pig sapan and endosapan debigatron is also known as pradexa and rivaroxaban is also known as alto a pizza ban is also known as eliquis andoxo ban is not so much in use the most frequently uh used amongst these are

Typographer clocks abandon a pixelman so we’ll deal with each of these in detail so i’ll begin with the warfarin one coming towards iron warfarin is as i’ve already told you is a vitamin k antagonist and it deals with factor two seven nine and ten okay so but it is very cheap drug most commonly drug but it comes with its disadvantages also because it has

A lot of drug plus food interactions so whenever we put patients on that warfarin we tell them not to have green leafy vegetables because it tends to affect the inr and it also requires a lot of monitoring with respect to inr which needs to be checked weekly or monthly the bleeding risk is also quite high with warfarin the onset of action is also very slow in

One week you can see the onset of action coming to the reversal of warfarin if and if you patients are on warfarin and tend to have a very high nrn you have to judge like what to give them for the reversal of this high inr and there’s a risk of bleeding in the body we have vitamin k antagonist vitamin k injection i’m sorry for that vitamin k injections vitamin

K injection is given as 10 mg of iv over 10 minutes that comes up to like 1 mg per minute and then you can repeat your inr and see if you have reached your therapeutic range and uh you can repeat uh next year also and usually we get for like three days to reverse the range of to reverse the inr and bring it down to the range so coming down to the other

Noble anticoagulants that is no arcs as we know it the n here stands for noble oral anticoagulants as i’ve discussed this is javigatron rivaroxaban and apixaban okay so debigratron although all these drugs a little expensive but they have the advantage of not so bleeding and quick onset of action quick one set and they do not require so much of monitoring

Not requires monitoring as it is required in warfarin so we’ll each deal with each of these in details adaptation is used when a patient is at risk of forming clots in their body either there’s a hip or knee surgery or patient has atrial fibrillation and there’s a risk of stroke or malignancies all these requires the patient to be put on blood thinners or

Any dvd prophylaxis also is required in any patient and also they can be used as a treatment for pulmonary thromboembolism and treatment of dvt also so this is the indication of debigatron all of these so when you when you know the indication then you want to start the patient on any of this medication depicting also known as pradaxa so it comes in two doses

Based on the creatinine clearance of the patient you put the patient on either 150 mg of bd twice a day if the creatinine clearance is more than 30 ml per minute and if it is less than 30 ml per minute then the dosage is 75 mg of bd so among all the new arcs have a bd dosaging but only river oxyban is only od other than that all are bd so now you have put the

Patient on um pradaxa and he’s doing well you don’t require inr monitoring as such um but then you find something um somewhere bleeding in the patient and it comes with the bleeding when the patient is on derby catering and then you get the pti done for them and you find that they also have a deranged creatinine clearance some aka has occurred and then they have

Started accumulating derby attention in the body the metabolism is affected because typography is primarily excreted by the kidney and whenever the patient has aki or any kidney injury they tend to bullet david gatrin inside and then they land up with bleeding tendency so now you want to revert these uh bleeding so what do we add what do we have at hand is only

Two of these we the most uh specific one is idari sumab ida rizumab is a monoclonal antibody which is given at uh dosage of uh 5 grams of iv okay but then this is very costly like it is in lux in india so it is rarely available in the pharmacy to to get your hands on so what we have at hand is pcc pcc is also known as pro thrombin complex concentrate this

Is easily available in your hospital so you can use it at a range of 50 international units per kg iv single dose only to reverse this bleeding that has occurred with derby atrium you do not use not to use ffp and not to use vitamin k because it won’t help you ffp although you can use some time in their emergencies when you don’t have either pcc or idahosumab but

Then it is only for like a fluid resuscitation sort of thing it will do but not so much of a help over here the other things that we will be dealing with here is rivaroxaban rivaroxaban is also known as cerralto the indications are same over here also like a hip or knee surgery uh so you want to uh give the thromboprophylaxis in hippony surgery or dvt profile

Access for them so it is uh the advantage of rivaroxaban is an od dosing now here also you need to see the creatinine of the patient it depends on the creatinine if creatinine is more than 50 creatinine clearance although more than 50 ml per minute it has dose of 20 mg od or if it’s less than 50 the dosage is 10 mg od now uh rivaroxaban also doesn’t have a like

Reversal dosages new ones that is available here is andexonet you just have to remember the name because it is rarely available in any of the hospitals the other one that we have is eliquis eliquis is also known as a pizza pan rivaroxaban and apixaban both belong to the group of factor 10a inhibitors these are 10a inhibitors this also is factor 10a inhibitors the

Indications remain the same if you want to choose among debbie gatrin rivaroxaban and a pixar band a pizza ban is rarely a favor it’s a mostly favorite sorry among deborah gat trend reversals and a pizza ban the dosage is also uh very good but also here also it depends upon the creatinine if it’s more than 1.5 then you have to give 2.5 mg bd and if it’s less than

1.5 that is a normal creatine actually the dose is 5 mg bd so here also if any of your patients is either on rivaroxaban or a pixaban and they come with the bleeding because they have a raised creatinine or aki then you have uh uh two things that hand or maybe one thing only you have pcc only to reverse that bleeding dosage as i’ve already discussed so i think

I have covered all the oral antiquarians in detail uh that is warfarin then here we have dabigatran rivaroxaban and apixaban and uh this is now usually favored because of the dosaging and then the not so much of requirement of the inr um per se in this in these medications and among these also pick zapana’s little bit favored so i hope i’ve cleared all your doubts thank you so much

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Oral Anticoagulants By MEDICINE in a Minute