Stroke - Anticoagulation
Coagulation cascade
DOAC
Direct factor Xa inhibitor
-prevent thrombin formation
>Apixaban (Eliquis)
>Rivaroxaban (Xarelto)
>Edoxaban (Lixiana)
>Betrixaban (Bevyxxa)
Direct thrombin inhibitor
>Dabigatran (Pradaxa)
VKA
-Warfarin (Coumadin)→ deplet CS 1972
>Vit K-dependent clotting factors (protein C, protein S, X, IX, VII, II)
Heparin
-Factor Xa inhibitor
UFH
-IV Hep
LMWH
-Enoxaparin (Lvenox), Dalteparin (Fragmin), Tinzaparin (Innohep)
Fondaparinux
(Arixtra)
-IV, if HIT
Parenteral direct thrombin inhibitor
-Argatroban
-Bivalirudin
Consider in stroke
Afib→ DOAC
Mechanical valve stroke→ warfarin
CVST→ heparin transition DOAC/warfarin
Cancer-assocaited stroke→ LMWH or DOAC
APS-related stroke→ warfarin
Reversal agents
Andexanet alfa
>Only given if NSGY indication
TNK
- Cryoprecipitate to replenish fibrinogen
- Tranexamic acid or aminocaproic acid can be administered to prevent further fibrinolysis