№ 29Cardiology15 min read
Anticoagulant therapy and monitoring
1. Big picture
Anticoagulants prevent and treat fibrin-rich thrombi, especially in venous thrombosis, pulmonary embolism, atrial fibrillation-related embolic stroke prevention, mechanical valves, and intracardiac thrombus. The examiner wants you to know four things:
- Which anticoagulant to choose
- How to monitor it
- When it is contraindicated
- How to reverse it in bleeding
Core exam distinction:
| Situation | Main treatment logic |
|---|---|
| Venous thromboembolism: deep vein thrombosis/pulmonary embolism | Anticoagulation |
| Atrial fibrillation stroke prevention | Anticoagulation according to thromboembolic risk |
| Mechanical valve / severe mitral stenosis | Vitamin K antagonist, not direct oral anticoagulant |
| Acute coronary syndrome / arterial thrombosis | Mainly antiplatelet therapy, plus anticoagulation acutely |
| Established major bleeding | Stop anticoagulant + reverse if severe |
Direct oral anticoagulants (DOACs) are now preferred in many patients because they have rapid onset, fixed dosing, and usually do not require routine laboratory monitoring, but they are not suitable for every patient.
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