Anticoagulation Reversal

Question 1

Bleeding causing fall in Hgb of >= __ g/dL or transfusion with __ or more units of packed RBCs is major bleeding

Answer 1

2, 2

Question 2

Transfusion of at least __ units of packed RBCs is life-threatening bleed

Answer 2

4

Question 3

Reduction in Hgb of at least __ g/dL is life-threatening bleed

Answer 3

5

Question 4

RR arrived at his PCP complaining of weakness, increased bruising on arms, and a recent fall. Patient states he did not hit his head when he fell but his hip is largely bruised and is painful to touch. His PCP sends RR to the ED in which he was admitted for further evaluation.

Which is the correct classification?

a. major bleeding
b. clinically relevant non-major bleeding
c. minor bleeding
d. life-threatening bleeding

Answer 4

b. clinically relevant non-major bleeding

Question 5

Measuring anticoagulant activity:

Normal TT excludes therapeutic drug level; dilute TT, ECA, eCT can quantify drug levels

a. dabigatran
b. rivaroxaban
c. apixaban
d. edoxaban

Answer 5

a. dabigatran

Question 6

What is the best measure activity for rivaroxaban, apixaban, edoxaban?

Answer 6

anti-Xa

need specific drug assay

Question 7

What is the reversal agent for heparin?

Answer 7

protamine

rapid reverses full anticoagulant activity of heparin

Question 8

What is the max dose of protamine?

Answer 8

50mg

1mg of protamine neutralizes approximately 100 units of UFH

Question 9

The rate of warfarin hemorrhage increases markedly in pts with an INR > __

Answer 9

4.5

Question 10

Hold warfarin and give vitamin K with what INR?

Answer 10

> 10

Question 11

Doses of vitamin K over __ mg are generally not recommended

Answer 11

10

Question 12

Full effect of vitamin K for coagulation reversal is __hrs after administration

Answer 12

24

partial in 6-12hrs

Question 13

PCC-4 factor must be thawed, and needs ABO matching

a. true
b. false

Answer 13

b. false

Advantages:

• NO need to thaw
• NO need for ABO matching

Question 14

PCC-4 factor and activated PcC-4 factor are __ volume

a. large
b. small

Answer 14

b. small

Question 15

Which has greater thrombosis risk?

a. PCC-4 factor
b. activated PCC-4 factor

Answer 15

b. activated PCC-4 factor

Question 16

PCC is used for warfarin reversal

a. true
b. false

Answer 16

a. true

Question 17

4-factor PCC (Kcentra) is dosed using units of __ per kg of body weight

Answer 17

factor IX

Question 18

What weight is used for dose gah warfarin reversal agent 4-factor PCC?

a. AdjBW
b. TBW
c. Actual BW

Answer 18

c. Actual BW

must give with vitamin K

repeat dosing not recommended

Question 19

Which warfarin reversal agent restores all clotting factors?

a. fresh frozen plasma
b. 4factor PCC
c. vitamin K

Answer 19

a. fresh frozen plasma

Question 20

Which requires ABO blood match and thawing?

a. fresh frozen plasma
b. 4factor PCC
c. vitamin K

Answer 20

a. fresh frozen plasma

also given with large amount of fluid, so not used in volume sensitive pts

Question 21

Which warfarin reversal agent is really effective at decreasing INR but may be associated with increased thrombosis?

Answer 21

recombinant factor VIIA (NovoSeven RT)

Question 22

Serious thrombotic AEs are associated with the use of __ outside labeled indications

Answer 22

NovoSeven RT (recombinant factor VIIA)

Question 23

What is the antidote used ONLY for rivaroxaban and apixaban?

Answer 23

andexanet alfa

Question 24

What is dose of factor Xa reversal agent andexanet alfa?

Answer 24

400-800mg IV bolus, then 4-8mg/min infusion for 2 hours

rivaroxaban and apixaban

Question 25

Idarucizumab is used for reversal of what agent?

Answer 25

dabigatran

Question 26

The dose of the dabigatran reversal agent idarucizumab is __ units/kg IV x 1

Answer 26

50

Question 27

What is the max dose of idarucizumab?

Answer 27

5000 units

Question 28

Which is most appropriate reversal agent for a pt on dabigatran?

a. andexanet alfa
b. idarucizumab
c. PCC-4 factor
d. vitamin K 10mg PO

Answer 28

b. idarucizumab