Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

DRUG (UK Name)	MOA	DOSE (IV/Subcut)	DOSE PO	INDICATION	CONTRAINDICATION / CAUTION
Enoxaparin (Clexane)	Low Molecular Weight Heparin (LMWH); binds antithrombin III, inhibiting Factor Xa > IIa	1 mg/kg subcut every 12 h OR 1.5 mg/kg subcut daily	N/A	Prevention/treatment of PE, NSTEMI, unstable angina	Monitor anti-Xa in renal impairment or obesity (>150 kg). Avoid with spinal/epidural anaesthesia/puncture. Check BNF for pregnancy advice.
Heparin (Unfractionated)	Binds antithrombin III, inactivating thrombin and factors IX, Xa, XI, XII; prevents fibrin formation	VTE: 80 units/kg IV bolus, then 18 units/kg/h infusion ACS/Afib: 60 units/kg IV bolus, then 12 units/kg/h infusion	N/A	Venous thromboembolism, ACS (LMWH often preferred for NSTEMI)	Bleeding risk; Protamine sulfate can reverse. Check BNF for use in pregnancy (generally acceptable). Monitor APTT.
Protamine sulfate	Ionically binds and neutralises heparin	1 mg neutralises ~100 units of heparin (max 50 mg), give IV at ≤5 mg/min	N/A	Reversal of heparin-induced anticoagulation	Risk of anaphylaxis (especially if fish allergy), hypotension if infused rapidly; check with BNF for pregnancy considerations
Warfarin	Vitamin K antagonist, inhibits vitamin K epoxide reductase and reduces synthesis of factors II, VII, IX, X	Rarely given IV; usually oral	Typically start at 5 mg PO daily, adjust per INR	Prevention/treatment of VTE, stroke prevention in AF, mechanical heart valves	Contraindicated in pregnancy (especially first trimester and near term), active bleeding, multiple drug interactions. Regular INR monitoring required.
Apixaban (Eliquis)	Direct Factor Xa inhibitor	N/A	AF stroke prophylaxis: 5 mg PO twice daily VTE treatment: 10 mg PO twice daily for 7 days, then 5 mg PO twice daily	Stroke prevention in AF, VTE treatment	Active bleeding, caution in severe hepatic impairment. Check BNF for pregnancy advice.
Dabigatran (Pradaxa)	Direct thrombin (Factor IIa) inhibitor	N/A	AF stroke prophylaxis: 150 mg PO twice daily (adjust for renal function)	Stroke prevention in AF, VTE treatment	Active bleeding, contraindicated in patients with mechanical heart valves, check BNF for use in pregnancy.
Rivaroxaban (Xarelto)	Direct Factor Xa inhibitor	N/A	AF stroke prophylaxis: 20 mg PO once daily with food VTE treatment: 15 mg PO twice daily for 21 days, then 20 mg PO once daily	Stroke prevention in AF, VTE treatment	Active bleeding, severe hepatic impairment, check BNF for pregnancy advice.
Vitamin K (Phytomenadione)	Essential cofactor for synthesis of vitamin K-dependent clotting factors	Serious bleeding on warfarin: 5–10 mg IV given slowly	Mildly elevated INR without significant bleeding: 2.5–5 mg PO	Warfarin reversal, correction of vitamin K deficiency	Rare hypersensitivity reactions with IV infusion, anaphylactoid reactions if infused rapidly. Consult BNF for pregnancy guidance.
Idarucizumab (Praxbind)	Monoclonal antibody fragment that binds dabigatran, neutralising its effect	5 g IV total (given as two 2.5 g doses no more than 15 min apart)	N/A	Reversal of dabigatran anticoagulant effect	Hypersensitivity reactions possible. Check BNF for pregnancy advice.

Emergency Haematology Drugs

Check all doses with BNF or equivalent UK guidelines

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