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Therapeutics II > Anti-Coagulation In Lecture > Flashcards

Anti-Coagulation In Lecture Flashcards

(54 cards)

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1
Q

Virchow’s Triad

A
  • abnormalities of clotting components (hypercoagulable state)
  • abnormality of surfaces in contact with blood flow (endothelial injury)
  • abnormalities in blood flow (circulatory stasis)
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2
Q

DOACs for post operative prophylaxis

A
  • dabigatran
  • rivaroxaban
  • apixaban
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3
Q

Dabigatran dosing changes (post-op prop doses)

A
  • day of surgery = 110 mg QD
  • not day of surgery = 220 mg QD
  • maintenance dose = 220 mg QD
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4
Q

Dabigatran is for ____ only

A

HIP ONLY

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5
Q

Rivaroxaban dosing (post-op prop doses)

A

10 mg QD x35 days

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6
Q

Apixaban dosing (post-op prop doses)

A

2.5 mg BID x 35 days

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7
Q

Rivaroxaban (post-op prop doses) avoid use when

A

CrCl is < 30 ml/min

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8
Q

DOACs for non-valvular atrial fibrillation

A
  • dabigatran
  • rivaroxaban
  • apixaban
  • edoxaban
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9
Q

Dabigatran (non-valvular atrial fibrillation dosing)

A

150 mg BID

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10
Q

Rivaroxaban (non-valvular atrial fibrillation dosing)

A

20 mg QD

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11
Q

Apixaban (non-valvular atrial fibrillation dosing)

A

5 mg BID

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12
Q

Edoxaban (non-valvular atrial fibrillation dosing)

A

60 mg PO QD

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13
Q

Remember that all DOACs are

A

adjusted for renal flow

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14
Q

How to renally adjust DOACs for non-valvular atrial fibrillation dosing

A
  • dabigatran, rivaroxaban, edoxaban are adjusted based on CrCl
  • Apixaban dosing based on SCr
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15
Q

Edoxaban should not be used for non valvular atrial fibrillation when

A

CrCl is > 95 ml/min

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16
Q

Apixaban dosing for non-valvular atrial fibrillation is based on (3 things)

A
  • age (>/= 80)
  • SCr (< 1.5 mg/dl)
  • Weight (= 60 kg)
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17
Q

DOACs for DVT/PE treatment

A
  • dabigatran
  • rivaroxaban
  • apixaban
  • edoxaban
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18
Q

Dabigatran DVT/PE treatment dosing

A

150 mg BID

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19
Q

Rivaroxaban DVT/PE treatment dosing

A

15 mg BID x 3 weeks, then 20 mg QD

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20
Q

Apixaban DVT/PE treatment dosing

A

10 mg BID x7 days, followed by 5 mg BID

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21
Q

Edoxaban DVT/PE treatment dosing

A

60 mg QD

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22
Q

Apixaban renal adjustment dosing based on

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A

SCr (> 2.5 mg/dL)

23
Q

DOACs for DVT/PE tx: dabigatran and edoxaban…

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A

require 5 - 10 days parental anticoagulation

24
Q

Edoxaban (DVT/PE treatment) is wt is

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A

= 60 kg = dose is 30 mg QD

25
For DVT/PE tx, which DOACs don't require parental anticoagulation
rivaroxaban and apixaban
26
DOACs for secondary treatment of recurrent DVT/PE
rivaroxaban and apixaban
27
Rivaroxaban dosing for secondary treatment of recurrent DVT/PE
20 mg PO QD
28
Apixaban dosing for secondary treatment of recurrent DVT/PE
2.5 mg PO BID
29
For both rivaroxaban and apixaban for secondary treatment of recurrent DVT/PE...
this is considered after an initial 6 months of treatment (these drugs can be used during months 6 - 12)
30
DOACs that can be used for VTE prophylaxis (for acutely ill patients)
rivaroxaban and BETRIXABAN (ONLY PLACE THIS SHOWS UP)
31
Rivaroxaban VTE prophylaxis dosing
10 mg PO QD (31 - 39 days)
32
Betrixaban VTE prophylaxis dosing
160 mg PO QD (Day 1); 80 mg PO QD (35 - 42 days)
33
Warfarin Initial Dose (same dose if unsure)
5 mg PO QD
34
Warfarin Initial Dose for Healthy Outpatients
10 mg PO QD
35
Warfarin should be overlapped with
UFH or LMWH for at least 5 days and until INR is therapeutic
36
Must adjust the ______ dose to achieve therapeutic INR
weekly dose
37
The one exception when a pt may be started on just warfarin
when the pt has atrial fibrillation
38
Goal INR of 2.0 - 3.0 recommended for pts with
- prophylaxis of VTE - tx of VTE or PE - Prevention of systemic embolism (tissue heart valves, AMI, valvular heart disease, atrial fibrillation) - antiphospholipid antibody syndrome - mechanical heart value (aortic)
39
INR goal of 1.5 - 2.0 when
the pt has an aortic valve replacement - mechanical On-X
40
INR goal of 2.5 - 3.5 when
the pt has a mechanical heart valve (mitral, caged ball, high risk)
41
AMI is an oral anticoagulant that prevents
recurrent MI, INR of 2.5 - 3.5 is recommended
42
Warfarin Maintenance therapy: If dose held today
check within 1 - 2 days
43
Warfarin Maintenance therapy: If dose change today
check within 1 - 2 weeks
44
Warfarin Maintenance therapy: If dosage change = 2 weeks ago
check within 2 - 4 weeks
45
Warfarin Maintenance therapy: Routine follow-up for stable pt
check every 4 - 6 weeks
46
Warfarin Maintenance therapy: Routine follow-up for unstable pt
check every 1 - 2 weeks
47
Warfarin Maintenance therapy: Consistently stable (i.e. no change in 6 months
check every 12 weeks
48
Patient Interview: Warfarin Questions
* 5 Ds: - Drugs (interactions) - Diseases (changes in overall medical condition) - Doses (any missed doses) - Diet (any changes, specifically leafy green vegetables) - Drink (any alcohol consumption) *Bruising/bleeding
49
When to have a warfarin dose adjustment
- s/sx of bleeding - thromboembolic complications - prescription medication changes - diet - activity - etoh use - AE - OTC drug use - drug interaction screening
50
Warfarin Protocol: Goal = 2.0 - 3.0
- INR < 2 = Increase 5 - 15% - INR 3.1 - 3.5 = Decrease by 5 - 15% - INR 3.5 - 4.0 = Hold 0 - 1 dose, decrease by 10 - 15% - INR > 4.0 = Hold 0 - 2 doses, decrease by 10 - 15%
51
Warfarin Protocol: Goal = 2.5 - 3.5
- INR < 2.5 = Increase 5 - 15% - INR 3.6 - 4.0 = Decrease by 5 - 15% - INR 4.1 - 4.5 = Hold 0 - 1 dose, decrease by 10 - 15% - INR > 4.5 = Hold 0 - 2 doses, decrease by 10 - 15%
52
Bridging warfarin not required for
new anticoagulants and typically not for dental, dermatologic, or cataract procedures
53
In warfarin bridging is needed (i.e. during an invasive procedure)
-stop warfarin 5 days before surgery - give LMWH or UFH until the procedure * **stop LMWH 24 hrs before procedure * **stop IV UFH 4 - 6 hrs before procedure -resume warfarin 12 - 24 hours after surgery (assuming adequate hemostasis)
54
The LMWH usually used to bridge warfarin is
enoxaparin

Therapeutics II (12 decks)

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