Final year

Anticoagulation and Antithrombotic Therapy

Anticoagulant and antiplatelet prescribing in UK practice, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers warfarin, heparins and direct oral anticoagulants, INR monitoring, renal dosing and reversal, DVT and pulmonary embolism, VTE prophylaxis, stroke prevention in atrial fibrillation, acute stroke and limb ischaemia, and the interactions that make these drugs dangerous.

3 modules · 22 lessons 5 h EN

What you will be able to do

Explain the mechanism of action, monitoring requirements and reversal options for warfarin, unfractionated heparin, low molecular weight heparins and the direct oral anticoagulants.
Interpret INR and other monitoring results and adjust anticoagulant therapy in line with current UK guidance.
Select an appropriate anticoagulant for venous thromboembolism treatment or prophylaxis, accounting for renal function, body weight and clinical setting.
Assess stroke and bleeding risk in atrial fibrillation and justify an anticoagulation decision, including in chronic kidney disease.
Identify clinically important interactions and high-risk prescribing errors involving anticoagulants and antiplatelets.
Describe the immediate management of major bleeding, including when reversal agents are indicated and when to seek specialist help.
Write and review a safe anticoagulant prescription, explaining the monitoring, counselling and follow-up it requires.
Outline thrombolysis and thrombectomy pathways in massive pulmonary embolism, acute ischaemic stroke and acute limb ischaemia.

About this course

Course overview

Anticoagulation and antithrombotic therapy sits at the intersection of pharmacology, haematology and general medicine, and it is where prescribing errors cause the most harm. This course takes you from mechanism to bedside decision: why warfarin needs monitoring and a direct oral anticoagulant usually does not, how to choose an agent in renal impairment, and what to do when a patient on an anticoagulant bleeds.

Coverage follows UK practice, with British National Formulary dosing and NICE-style guidance. Where guidance differs between countries, for example in the use of CHA₂DS₂-VASc versus CHA₂DS₂-VA for stroke risk in atrial fibrillation, or in the availability of specific reversal agents, the course says so.

Who it suits

Final-year medical and pharmacy students preparing for finals, and foundation doctors preparing for the Prescribing Safety Assessment or their first ward rotations. It suits learners who already know the basics of haemostasis and want structured practice in making and defending prescribing decisions.

What you will cover

Module 1: Anticoagulant pharmacology

Warfarin inhibits vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX and X and of proteins C and S. Unfractionated heparin and low molecular weight heparins act by potentiating antithrombin; dabigatran inhibits thrombin directly, while rivaroxaban, apixaban and edoxaban inhibit factor Xa. The module covers INR monitoring, renal dosing, the interactions that destabilise warfarin (amiodarone, azoles, macrolides, rifampicin, enzyme inducers, drugs affecting platelets) and reversal of each agent in bleeding.

Module 2: Venous thromboembolism

Diagnosis and treatment of deep vein thrombosis and pulmonary embolism, including risk stratification, thrombolysis in haemodynamically unstable pulmonary embolism, choosing an anticoagulant when renal function is poor, and risk-assessed prophylaxis. Special populations are addressed, including obesity and pregnancy, where dosing and monitoring practice varies and expert guidance should be followed.

Module 3: Arterial thrombosis

Stroke prevention in atrial fibrillation, comparing stroke risk with bleeding risk, anticoagulant selection, and duration of dual antiplatelet therapy after acute coronary syndrome or stenting.

Agent	Target	Reversal in major bleeding
Warfarin	Vitamin K dependent factors	Vitamin K plus prothrombin complex concentrate
Unfractionated heparin	Antithrombin mediated	Protamine sulfate
Low molecular weight heparin	Predominantly factor Xa	Protamine sulfate (partial)
Dabigatran	Thrombin	Idarucizumab
Factor Xa inhibitors	Factor Xa	Andexanet alfa where available; prothrombin complex concentrate as an alternative

How the course is taught

Every module pairs teaching with hands-on practice. You work through branching clinical cases, prescribing scenarios checked against safety rules and a quiz. Doses appear as teaching examples only, and prescribing decisions are assessed against defined safety criteria rather than clinical advice.

A final exam gates the certificate. Content provided through Oskela is intended for education and training. It is not a substitute for professional clinical judgment, institutional protocols, current formularies, prescribing information, or specialist consultation.

Curriculum

3 modules · 22 lessons

This module covers how warfarin, unfractionated heparin, low molecular weight heparins and the direct oral anticoagulants work, how their effect is monitored, how dosing changes in renal impairment, which interactions matter most, and how each agent is reversed in bleeding. Doses and thresholds are teaching examples; always check the current British National Formulary and local protocols.

Warfarin and the Vitamin K Antagonists: Mechanism, INR Monitoring, Interactions and ReversalPreview
Warfarin remains a common anticoagulant in UK practice, and its narrow therapeutic index makes monitoring and interaction management essential. This lesson explains how warfarin inhibits vitamin K epoxide reductase, why its onset is delayed and parenteral cover is needed, how INR targets are set and monitored, BNF-based loading and maintenance dosing, the interactions that matter most, and reversal with vitamin K, prothrombin complex concentrate, or plasma. It is pitched for final-year medical and pharmacy students and foundation doctors preparing for finals and the Prescribing Safety Assessment.
10 min
Heparins: Unfractionated and Low Molecular Weight, Renal Dosing, Monitoring and Reversal
This lesson covers the pharmacology of unfractionated heparin (UFH) and low molecular weight heparins (LMWHs) for final-year medical and pharmacy students and foundation doctors. It explains how both agents act through antithrombin to inhibit thrombin and factor Xa, and how differences in molecular size and chain length translate into practical differences in bioavailability, half-life, monitoring and reversal. You will review prophylactic and treatment dosing, when to monitor with aPTT or anti-Xa, and how to adjust doses in renal impairment, obesity and pregnancy. The lesson also covers heparin-induced thrombocytopenia and reversal with protamine. Doses are teaching examples only; always check the current British National Formulary and local protocols.
10 min
Direct Oral Anticoagulants: Agent Choice, Renal Dosing, Interactions, Monitoring and Reversal in Bleeding
This lesson covers dabigatran, a direct thrombin inhibitor, and apixaban, edoxaban and rivaroxaban, the factor Xa inhibitors. It explains how these agents differ, how renal function affects elimination and dose reduction, and why routine coagulation monitoring is not used. It reviews clinically important P-glycoprotein and CYP3A4 interactions, and the approach to major bleeding: idarucizumab for dabigatran, and andexanet alfa or prothrombin complex concentrate for the factor Xa inhibitors. Doses, thresholds and reversal availability vary by region and formulary; all figures used here are teaching examples.
10 min
Case: A Warfarinised Elderly Man with a Fall: A Case of Fractured Neck of Femur
20 min
Prescribing: Community-acquired pneumonia in a penicillin-allergic patient taking warfarin
15 min
Prescribing: Lower UTI in an Elderly Woman on Warfarin with Renal Impairment
15 min
Quiz: Anticoagulant Pharmacology: Mechanisms, Monitoring, Dosing and Reversal
9 min

This module covers venous thromboembolism from presentation to prevention. It begins with the diagnosis and treatment of deep vein thrombosis and pulmonary embolism, then addresses high-risk pulmonary embolism requiring thrombolysis and anticoagulant choice in renal impairment. The final lesson covers risk-assessed VTE prophylaxis, including weight-adjusted dosing in obesity and the perioperative bariatric and orthopaedic patient. Teaching uses UK practice, British National Formulary dosing and NICE-style recommendations, noting where practice varies by region or formulary.

Diagnosing DVT and PE and Starting Treatment: Clinical Probability, Imaging, Initial Anticoagulation and Duration
This lesson covers the diagnosis and initial treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). It reviews clinical features, validated probability scores such as the Wells score, D-dimer interpretation and its limitations, and imaging with compression ultrasound, CT pulmonary angiography and ventilation-perfusion scanning. It then addresses starting anticoagulation before confirmation, selecting drugs and doses for initial treatment, outpatient management of low-risk DVT and PE, cancer-associated thrombosis, and the duration of anticoagulation. The content is pitched for final-year medical and pharmacy students and foundation doctors in UK practice.
10 min
High-Risk Pulmonary Embolism: Thrombolysis and Choosing an Anticoagulant in Renal Impairment
This lesson covers two linked decisions in acute venous thromboembolism. First, how to stratify pulmonary embolism by haemodynamic stability and markers of right ventricular strain, and when that stratification justifies systemic thrombolysis, including its absolute and relative contraindications and the options when thrombolysis fails or is unsafe. Second, how renal function and dialysis status guide the choice and dose of low molecular weight heparin, unfractionated heparin, fondaparinux and direct oral anticoagulants, and which agents must be avoided. Doses are teaching examples drawn from UK practice, and local formularies and protocols vary.
10 min
Risk-Assessed VTE Prophylaxis: Medical, Surgical and Obstetric Patients, Obesity and Bariatric Surgery
This lesson covers risk-assessed venous thromboembolism prophylaxis across medical, surgical and obstetric admissions, with particular attention to patients with obesity and those undergoing bariatric surgery or hip replacement. It works through structured VTE and bleeding risk assessment on admission and at reassessment, then compares low molecular weight heparin, unfractionated heparin, fondaparinux and mechanical methods. It explains when to combine pharmacological and mechanical prophylaxis and when to extend prophylaxis beyond discharge, how weight-adjusted dosing and dose capping are handled in obesity, when anti-Xa monitoring may be considered, and how to time doses around neuraxial anaesthesia. Doses used are teaching examples only. Local protocols, current formularies and prescribing information govern practice and vary by region.
10 min
Case: Massive Pulmonary Embolism in a Postoperative Patient
20 min
Prescribing: Confirmed Proximal Deep Vein Thrombosis: Outpatient Anticoagulation
15 min
Prescribing: Pulmonary embolism in renal impairment
15 min
Prescribing: VTE Prophylaxis in a Bariatric Patient Undergoing Hip Replacement
15 min
Quiz: Venous Thromboembolism: Diagnosis, Acute Treatment, Special Populations and Prophylaxis
8 min

This module covers arterial thrombotic disease from prevention to acute intervention. It covers stroke prevention in atrial fibrillation using CHA2DS2-VASc and bleeding risk assessment, anticoagulant choice and dosing in chronic kidney disease, reperfusion decisions in acute ischaemic stroke, and the recognition and management of acute limb ischaemia. Teaching is set in UK practice with British National Formulary dosing and NICE-style guidance, noting where practice varies by region or formulary.

Stroke Prevention in Atrial Fibrillation: CHA2DS2-VASc, Bleeding Risk and Choosing an Anticoagulant
Atrial fibrillation raises the risk of cardioembolic stroke because blood stagnates in the left atrial appendage. This lesson covers how to estimate stroke risk with CHA2DS2-VASc, how to weigh that against bleeding risk using tools such as HAS-BLED or ORBIT, and when anticoagulation is indicated rather than antiplatelet therapy. It then works through the choice between a direct oral anticoagulant and a vitamin K antagonist, including renal function checks, common drug interactions, and the practical points to cover with patients about bleeding, missed doses and adherence. Doses are teaching examples only; always check current national guidance and the summary of product characteristics for the patient in front of you.
10 min
Anticoagulation in Chronic Kidney Disease: Renal Dosing, Drug Choice and Monitoring
Chronic kidney disease changes both the risk of stroke and the handling of every anticoagulant used in atrial fibrillation. This lesson covers how declining clearance alters drug exposure, why creatinine clearance rather than eGFR alone drives licensed dosing, and the renal cut-offs that determine whether apixaban, rivaroxaban, edoxaban or dabigatran can be used. It then examines warfarin in advanced kidney disease and dialysis, the limited evidence in dialysis populations, and how to weigh stroke against bleeding risk. Monitoring, drug interactions, gastroprotection and structured dose review close the lesson.
10 min
Acute Ischaemic Stroke and Acute Limb Ischaemia: Reperfusion Decisions and Immediate Management
This lesson covers two arterial thrombotic emergencies. It begins with time-critical assessment of suspected acute ischaemic stroke, from prehospital alert to immediate brain imaging, and how eligibility for intravenous thrombolysis and mechanical thrombectomy is judged: time windows, large vessel occlusion and key contraindications. It then covers blood pressure, glucose and anticoagulant considerations around reperfusion, including patients already taking warfarin or a direct oral anticoagulant, followed by post-reperfusion monitoring, haemorrhagic transformation, angioedema, swallow assessment and when to restart anticoagulation. The second half addresses acute limb ischaemia: recognition using the six Ps, Rutherford categories, threatened versus viable limb, immediate unfractionated heparin, urgent imaging and referral for revascularisation. Doses are teaching examples only.
10 min
Case: Acute Stroke Thrombolysis and Thrombectomy Decision
20 min
Case: A 70-Year-Old Woman with Atrial Fibrillation and a Cold, Pale, Painful Leg
20 min
Prescribing: Atrial fibrillation with chronic kidney disease: anticoagulation
15 min
Quiz: Arterial Thrombosis and Anticoagulation: Stroke Prevention in Atrial Fibrillation, Acute Ischaemic Stroke and Acute Limb Ischaemia
9 min

Before you start

Basic pharmacology of haemostasis and the coagulation cascade.
Core prescribing principles, including renal dose adjustment and drug interactions.
Ability to interpret a full blood count and coagulation screen.
Basic life support awareness.

Who this is for

Final-year medical students preparing for finals and the Prescribing Safety Assessment.
Final-year pharmacy students preparing for registration assessments.
Foundation doctors in their first two years of practice.

Your instructor

Platform Administrator

Other courses

Pharmacokinetics
A free course for medical, pharmacy and nursing students who want a working grasp of how the body handles drugs. It covers absorption, distribution, metabolism and excretion, then clearance, volume of distribution, half-life and bioavailability, and applies them to concentration-time curves, steady state, loading and maintenance doses, and dose adjustment when renal or hepatic function changes.
Therapeutic Drug Monitoring and Prescribing Calculations
For final-year medical students preparing for finals and the Prescribing Safety Assessment (PSA), final-year pharmacy students, and foundation doctors. Topics: prescribing calculations, applied pharmacokinetics and therapeutic drug monitoring of narrow-therapeutic-index drugs, and interpreting potassium, sodium, renal, thyroid and liver results. UK practice, BNF dosing and NICE-style guidance. Pharmacy students do not sit the PSA.
Adverse Drug Reactions and Pharmacovigilance
For final-year medical students preparing for finals and the PSA, final-year pharmacy students and foundation doctors. Covers what counts as an ADR, A to F and DoTS classification, WHO-UMC and Naranjo causality, severity versus seriousness, type A reactions, allergy, organ-specific harm, and Yellow Card reporting. Every module closes with a quiz. Practice includes prescribing scenarios, timed OSCE stations and ADR cases to assess and report.
Safe Prescribing in Special Populations
Prescribing where standard adult doses cause harm, in UK practice with British National Formulary dosing, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers renal and hepatic impairment, pregnancy and breastfeeding, weight-based dosing in children, polypharmacy and deprescribing in older people, and serious interactions and adverse drug reactions.
Pain, Neurology and Mental Health Prescribing
Pain, neurological and psychiatric prescribing in UK practice, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers the analgesic ladder, opioid and NSAID safety, neuropathic pain, epilepsy and valproate risk, migraine, Parkinson's disease, depression, lithium, anxiety and sleep, psychosis, rapid tranquillisation and delirium. Doses follow the British National Formulary.
Respiratory Therapeutics
Respiratory drug therapy and assessment in UK practice, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers stepwise asthma management, inhaler technique, acute severe asthma in adults and children, COPD inhaled therapy and infective exacerbations, controlled oxygen and type 2 respiratory failure, and respiratory examination, chest radiographs and bronchiolitis.
Acute Medicine, Poisoning and Emergencies
Acute medicine and emergency prescribing in UK practice, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers ABCDE assessment, basic life support, anaphylaxis, poisoning and antidotes for paracetamol, opioids and lithium, alcohol withdrawal, intravenous fluids, acute kidney injury and hyperkalaemia, blood gases, upper GI and variceal bleeding, status epilepticus and subarachnoid haemorrhage.
Diabetes and Endocrine Therapeutics
Diabetes and endocrine prescribing in UK practice, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers choosing and intensifying type 2 diabetes therapy, insulin regimens and sick-day rules, hypoglycaemia, the variable rate insulin infusion, DKA and HHS, thyroid disease, corticosteroids and adrenal crisis, and calcium and sodium disorders. Dosing follows the British National Formulary.