anticoagulants + factor Xa

Question 1

What anticoagulants are associated with spinal/epidural hematomas?

Answer 1

Heparin, LMWHs, Fondaparinux.

Question 2

What procedures increase the risk for spinal/epidural hematomas?

Answer 2

Neuraxial anesthesia or spinal puncture.

Question 3

What is the most serious complication of spinal/epidural hematomas?

Answer 3

Long-term or permanent paralysis.

Question 4

What should be considered before spinal procedures in anticoagulated patients?

Answer 4

Risk of hematoma and paralysis.

Question 5

What clotting factors does warfarin block?

Answer 5

VII, IX, X, prothrombin.

Question 6

What does warfarin inhibit?

Answer 6

Vitamin K-dependent clotting factor synthesis.

Question 7

What are warfarin’s indications?

Answer 7

DVT, PE, A Fib, prosthetic heart valves, post-MI/TIA.

Question 8

How is warfarin administered?

Answer 8

Orally, once daily at the same time.

Question 9

Is warfarin safe in pregnancy?

Answer 9

No – contraindicated.

Question 10

What is the desired INR range for warfarin?

Answer 10

2–3.

Question 11

What lab values should be monitored on warfarin?

Answer 11

PT/INR.

Question 12

How long does warfarin take to work?

Answer 12

8–12 hours.

Question 13

What is the antidote for warfarin toxicity?

Answer 13

Vitamin K1 (PO: 2.5mg; IV: 0.5–1mg, dilute & infuse slowly), FFP/whole blood if needed.

Question 14

What are warfarin AEs?

Answer 14

Bleeding, hepatitis, liver damage (jaundice, N/V, dark urine, abd pain).

Question 15

What foods affect warfarin therapy?

Answer 15

Vitamin K foods (leafy greens) – keep intake steady.

Question 16

What other safety considerations should be taken for warfarin?

Answer 16

Avoid EtOH & OTC meds, wear medical alert bracelet.

Question 17

What decreases warfarin’s effectiveness?

Answer 17

Phenobarbital, carbamazepine, phenytoin, oral contraceptives, Vitamin K, CoQ-10.

Question 18

Route of administration – Heparin vs Warfarin?

Answer 18

Heparin: IV/SubQ; Warfarin: PO.

Question 19

Onset – Heparin vs Warfarin?

Answer 19

Heparin: rapid (minutes); Warfarin: slow (hours).

Question 20

Duration – Heparin vs Warfarin?

Answer 20

Heparin: short (hours); Warfarin: prolonged (days).

Question 21

Monitoring – Heparin vs Warfarin?

Answer 21

Heparin: aPTT; Warfarin: PT/INR.

Question 22

Antidote – Heparin vs Warfarin?

Answer 22

Heparin: Protamine sulfate; Warfarin: Vitamin K.

Question 23

What are examples of direct thrombin inhibitors?

Answer 23

Dabigatran (PO), Bivalirudin (IV), Desirudin (SQ), Argatroban (IV).

Question 24

What is dabigatran used for?

Answer 24

A Fib, prevent/treat DVT or PE.

Question 25

What is bivalirudin used for?

Answer 25

Given with ASA during coronary angioplasty.

Question 26

What is desirudin used for?

Answer 26

DVT prevention after total hip replacement.

Question 27

What is argatroban used for?

Answer 27

Prevent/treat thrombosis secondary to HIT.

Question 28

What are common AEs of direct thrombin inhibitors?

Answer 28

Bleeding, GI distress (N/V, reflux, ulcers), back pain (bivalirudin), injection site mass (desirudin).

Question 29

What should be monitored with dabigatran?

Answer 29

Multiple drug interactions.

Question 30

What increases bleeding risk with these drugs?

Answer 30

Other anticoagulants, thrombolytics, herbals.

Question 31

What are examples of direct Factor Xa inhibitors?

Answer 31

Rivaroxaban, Apixaban, Edoxaban.

Question 32

What are direct factor Xa inhibityors used for?

Answer 32

A Fib (stroke prevention), DVT/PE prevention and treatment, THA/TKA surgery.

Question 33

Are direct factor Xa inhibitors taken orally?

Answer 33

Yes – all PO.

Question 34

What are common AEs of Factor Xa inhibitors?

Answer 34

Bleeding, elevated liver enzymes, bilirubin.

Question 35

Do direct factor Xa inhibitors require regular monitoring?

Answer 35

No.

Question 36

What labs should still be checked occasionally?

Answer 36

Hgb, Hct, liver & kidney function.

Question 37

Are direct factor Xa inhibitor drugs expensive?

Answer 37

Yes – generally more costly than warfarin/heparin.

Question 38

Are there many drug interactions for direct factor Xa inhibitors?

Answer 38

Yes – monitor for interactions.