Which anticoagulant(s) enhances activity of antithrombin III and does not require aPTT or ACT monitoring?
a. Heparin c. Bivalirudin (Angiomax)
b. Enoxaparin (Lovenox) d. Argatroban (Argatroban)
B
Enoxaparin (Lovenox) enhances activity of antithrombin III, a more predictable response than heparin, because enoxaparin is not largely bound to protein. There is no need for activated partial thromboplastin time (aPTT) or ACT monitoring, and there is a lower risk of heparin-induced thrombocytopenia (HIT) than with unfractionated heparin (UFH). Heparin sodium enhances activity of antithrombin III, a natural anticoagulant, to prevent clot formation. The effectiveness of treatment may be monitored by aPTT or ACT. Response is variable because of binding with plasma proteins effects may be reversed with protamine sulfate. Bivalirudin (Angiomax) directly inhibits thrombin. It may be administered alone or in combination with glycoprotein IIb/IIIa inhibitors and produces a dose-dependent increase in aPTT and ACT. It may be used instead of UFH for patients with HIT. Argatroban (Argatroban) directly inhibits thrombin. It may be used instead of UFH for patients with HIT. Whereas ACT is monitored during percutaneous coronary intervention, aPTT is used during prolonged infusion.
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