Anticoagulant Therapy Course

Lesson 1 • Fibrinolysis and Clot Resolution

Explains plasminogen activation and fibrin degradation. Contextualises why anticoagulants differ from thrombolytics in clinical use.

Lesson 2 • Pathophysiology of Thrombosis

Describes arterial and venous thrombosis mechanisms and Virchow's triad. Establishes clinical rationale for anticoagulant intervention.

Lesson 3 • Key Coagulation Factors and Cofactors

Identifies the proteins central to clot propagation and their interdependencies. Builds vocabulary essential for understanding drug mechanisms in later chapters.

Lesson 1 • Parenteral Direct Thrombin Inhibitors

Covers argatroban and bivalirudin for settings where heparin is contraindicated. Connects to heparin-induced thrombocytopenia management introduced later.

Lesson 2 • Vitamin K Antagonists

Explains warfarin's inhibition of vitamin K epoxide reductase and its delayed onset. Sets the stage for INR monitoring and dietary interaction content.

Lesson 3 • Heparins: Unfractionated and Low-Molecular-Weight

Contrasts UFH and LMWH in mechanism, bioavailability, and monitoring needs. Anchors the heparin class before detailed dosing is addressed.

Lesson 4 • Direct Oral Anticoagulants

Introduces factor Xa inhibitors and direct thrombin inhibitors as a class. Highlights predictable pharmacokinetics that reduce routine monitoring needs.

Lesson 1 • Distribution and Protein Binding

Examines volume of distribution and plasma protein binding for key agents. Links protein binding to free drug concentration and therapeutic effect.

Lesson 2 • Absorption and Bioavailability Principles

Compares oral, subcutaneous, and IV routes for anticoagulant delivery. Explains why route choice affects onset and predictability of effect.

Lesson 3 • Drug-Drug Interaction Mechanisms

Classifies pharmacokinetic and pharmacodynamic interactions affecting anticoagulant response. Equips students to screen polypharmacy regimens for interaction risk.

Lesson 4 • Pharmacodynamic Variability

Addresses genetic, physiological, and disease-related sources of response variability. Prepares students to individualise therapy rather than apply uniform dosing.

Lesson 1 • Viscoelastic and Global Haemostasis Tests

Surveys TEG and ROTEM as point-of-care global coagulation assessments. Positions these tools for perioperative and critical care anticoagulation decisions.

Lesson 2 • aPTT and Heparin Monitoring

Covers aPTT methodology and its use in UFH titration. Addresses reagent sensitivity differences that affect target range selection.

Lesson 3 • Thrombin Time and Ecarin Clotting Time

Introduces TT and ECT for detecting direct thrombin inhibitor activity. Connects these specialised assays to parenteral DTI monitoring scenarios.

Lesson 4 • Anti-Xa Assays for LMWH and DOACs

Describes chromogenic anti-Xa testing for LMWH and its adaptation for DOAC quantification. Clarifies when anti-Xa levels guide clinical decisions.

Lesson 1 • DOAC Dosing and Renal Adjustment

Specifies standard and reduced DOAC doses tied to renal function thresholds and indication. Reinforces the importance of creatinine clearance calculation.

Lesson 2 • Bridging Therapy Principles

Explains periprocedural bridging rationale, timing, and patient selection criteria. Addresses the evidence base that has reduced routine bridging practice.

Lesson 3 • Warfarin Initiation and Dose Titration

Covers loading strategies, INR-guided dose adjustment algorithms, and time-in-therapeutic-range optimisation. Builds practical VKA management skills.

Lesson 4 • LMWH Dosing by Indication

Presents therapeutic and prophylactic LMWH dosing across VTE treatment, ACS, and surgical prophylaxis. Addresses renal dose adjustment criteria.

Lesson 1 • Specific DOAC Reversal Agents

Presents andexanet alfa and idarucizumab mechanisms, indications, and dosing. Distinguishes scenarios requiring specific reversal from supportive management.

Lesson 2 • Heparin Reversal with Protamine

Details protamine sulfate dosing calculations for UFH and partial LMWH reversal. Addresses protamine adverse reactions and monitoring after administration.

Lesson 3 • Classifying and Assessing Bleeding Events

Introduces major, clinically relevant, and minor bleeding definitions used in clinical trials and practice. Provides a framework for triage and urgency determination.

Lesson 4 • Supportive and Adjunctive Haemostatic Measures

Reviews tranexamic acid, activated charcoal, dialysis, and local haemostatic interventions. Complements specific reversal with general bleeding management strategies.

Lesson 1 • Anticoagulation During Pregnancy

Covers LMWH as the preferred agent, warfarin teratogenicity windows, and DOAC contraindication in pregnancy. Addresses postpartum anticoagulation planning.

Lesson 2 • Obesity and Extremes of Body Weight

Examines weight-based dosing challenges for LMWH and DOACs in obese patients. Addresses underweight patients with increased bleeding sensitivity.

Lesson 3 • Anticoagulation in Renal Impairment

Addresses drug accumulation, dose adjustment thresholds, and monitoring intensification for patients with reduced kidney function. Covers dialysis-specific considerations.

Lesson 4 • Heparin-Induced Thrombocytopenia

Covers HIT pathophysiology, 4T score diagnosis, and mandatory heparin cessation with alternative anticoagulation. Addresses thrombosis risk despite low platelet counts.

Lesson 1 • Thrombotic Risk Stratification Tools

Applies CHA2DS2-VASc, Caprini, and Wells scores to anticoagulation initiation decisions. Links risk score outputs to guideline-recommended therapy thresholds.

Lesson 2 • Medication Error Prevention

Identifies high-alert drug practices, look-alike name risks, and system-level safeguards for anticoagulants. Applies error taxonomy to root cause analysis.

Lesson 3 • Bleeding Risk Assessment

Uses HAS-BLED, ORBIT, and ATRIA scores to quantify bleeding risk before and during therapy. Balances bleeding risk against thrombotic risk in treatment decisions.

Lesson 4 • Patient Education and Adherence

Covers counselling on drug purpose, dietary interactions, missed doses, and bleeding recognition. Connects patient understanding to improved adherence and safety outcomes.