Mon11October0521AM 4
title: Anticoagulants tags: #FFICM #anticoagulant notebook: 🌑-FFICM type: bmj-anki
source: bmj-on-examination
Dabigatran etexilate is a prodrug that has an action on the coagulation pathway
Which one of the following is the most significant difference between dabigatran and other anticoagulants?
(Please select 1 option)
Activation of lipoprotein lipases
Active orally
Competitive thrombin inhibitor blocking both free and bound thrombin Correct
Reduced platelet aggregation
Inhibition of clotting factors II, VII, IX and X
Explanation
Dabigatran is used to prevent thromboembolism, particularly following knee and hip arthroplasty surgery. Dabigatran itself is not absorbed when given orally. However, pro-drug dabigatran etexilate has good oral bioavailability. It is converted to active drug by hydrolysis in the liver. Dabigatran is a potent, synthetic, reversible, non-peptide thrombin inhibitor. The inhibition of thrombin results in decreased formation of fibrin and reduces platelet aggregation. Dabigatran inhibits both free and fibrin-bound forms of thrombin, as well as thrombin induced platelet aggregation. The drug is administered by one daily dose and dose not require regular monitoring of effect.
Heparin binds to an enzyme inhibitor, antithrombin III, this in turn inactivates thrombin and factor Xa. Heparin als activates lipoprotein lipase involved in fat transport and binds to histamine and 5-HT receptors. It is not active orally but administered usually by intravenous and subcutaneous routes.
Warfarin also active orally inhibits the synthesis of vitamin K-dependent clotting factors these are Factors II, VII, IX, and X.
Idarucizumab, a monoclonal antibody fragment that has been developed to reverse the anticoagulant effect of dabigatran. It binds specifically to dabigatran and its metabolites and will not reverse the effects of other anticoagulants.
Answer Statistics
1
3%
2
9%
3
83%
4
4%
5
3%
Times answered: 232