Pharmacology, part 11: Cardiovascular Medications - Anticoagulants & Antiplatelets

by Cathy Parkes

In this video

Factor Xa inhibitors (rivaroxaban, apixaban)

  • What are they used for?
  • Mode of action
  • Easy tip to remember rivaroxaban
  • Side effects
  • Black box warning
  • Nursing care

Platelet aggregation inhibitors or antiplatelets (clopidogrel, abciximab)

  • What are they used for?
  • Mode of action
  • Easy tip for remembering what clopidogrel does
  • Side effects
    • Abciximab
  • Nursing care
    • Abciximab

Thrombin inhibitors (argatroban, dabigatran)

  • What are they used for?
  • Mode of action
  • Side effects
    • Argatroban
    • Dabigatran
  • Easy tip to remember these medications
  • Nursing care

Full transcript

Hi. In this video, we are going to continue covering some hematologic medications. Specifically, I'll be talking about a few more anticoagulant and antiplatelet medications.

So let's start off by talking about factor Xa inhibitors. Medications that fall within this class include rivaroxaban as well as apixaban, which is Eliquis.

So these medications are used to prevent a DVT, a stroke, or a PE in patients who have atrial fibrillation.

They work by selectively inhibiting factor Xa, which helps to block the coagulation cascade.

So the way I remember at least one of these medications, rivaroxaban, it looks like river. So if you take rivaroxaban, it will help your blood flow like a river because it's going to thin it out.

So side effects, bleeding is the big one to remember here. Anytime we have an anticoagulant, bleeding is always going to be a risk if we thin the blood too much, right, we do too much anticoagulation.

Another side effect is possible elevated liver enzymes with this medication.

In addition, this class of medication carries a black box warning because if you abruptly discontinue to use this medication, it places the patient at higher risk for thrombotic events.

So when your patient is on this medication, you want to monitor their liver function because of the risk of elevated liver enzymes. You're also going to want to monitor their hemoglobin and hematocrit during therapy.

Alright. Now let's talk about platelet aggregation inhibitors or antiplatelets. So the two medications that I'd be familiar with, that fall under this class, include clopidogrel and abciximab.

So abciximab is the medication that's spelled kind of funky. It's A-B-C and then so on which makes you wonder how they come up with these names. But that's what it is.

So these medications are used to prevent an MI or a stroke in patients who have acute coronary syndrome.

They work by inhibiting platelet aggregation.

So when I think about the medication clopidogrel, it looks like clop. The first of part of it, so I think about a horse clopping on platelets and preventing them from aggregating. So that's my little, silly way of remembering what clopidogrel does, what it's mode of action is.

So side effects with both of these medications: bleeding, right? Any time we have a anticoagulant or an antiplatelet, bleeding is going to be a key side effect.

With abciximab, you can also have hypotension tension as well as dysrhythmias and with clopidogrel, GI upset and rash are other side effects as well.

So if your patient is on one of these medications, you are definitely going to want to assess for bleeding.

And then, for abciximab, you're also going to want to pay attention to your patient's EKG and their vital signs because of the side effects of hypotension and dysrhythmias.

Alright, now let's talk about thrombin inhibitors. Two medications that fall within this class include argatroban and dabigatran.

These medications can be used to treat a DVT, a PE, they can help prevent a stroke, and they are also used with HIT or heparin-induced thrombocytopenia.

Their mode of action is to block thrombin receptors which helps to prevent the activation of clotting factors and the formation of a clot.

The key side effect with both of these medications is bleeding.

In addition, with argatroban, hypotension is a possible side effect, and with dabigatran, GI upset and angioedema are also possible side effects.

So the way I remember these medications and the key side effect of bleeding is I say, "There is no time to argue. You can't just dab at the blood. You need to hold pressure to stop the bleeding from argatroban or dabigatran. So again, key side effect is bleeding and anytime your patient is bleeding, you need to hold steady pressure on that area in order to stop the bleeding.

So the key thing you're going to be doing when a patient is on this therapy is assess for bleeding just like we've done with these other anticoagulants that we've talked about.

Okay. In my next video, we will be wrapping up our hematologic medications. We'll be talking about a hemostatic agent as well as a thrombolytic medication, and then we'll also be covering erythropoiesis, growth factors, and leukopoietic growth factors as well. So hang in there with me!

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