Blood Thinners

Question 1

When to maintain INR of 2.5

Answer 1

VTEs
AF
Cardioversion
MI
Cardiomyopathy

Question 2

When to maintain INR of 3.5

Answer 2

Recurrent VTEs
Mechanical heart valves

Question 3

What do with warfarin in major bleed

Answer 3

STOP warfarin
IV Phytomenadione
And
Dried prothrombin

Question 4

What do when INR >8 minor bleed

Answer 4

STOP wafarin
IV phytomenadione

Question 5

What to do when INR >8 no bleed

Answer 5

STOP warfarin
Oral phytomenadione

Question 6

What to do when INR 5-8 minor bleed

Answer 6

STOP warfarin
IV phytomenadione

Question 7

What to do when INR 5-8 no bleed

Answer 7

Withold 1-2 doses of warfarin

Question 8

What is monitoring and restart plan after INR>5

Answer 8

Restart when <5

monitor every 1-2 days then every 12 weeks

Question 9

MHRA side effect warfarin

Answer 9

Vascular calcification
Skin necrosis

Question 10

Side effects of warfarin

Answer 10

Bleeding antidote vit K phytomenadione

Teratogenic C/I in 1st and 3rd trimester
Women of childbearing potential should use contraception

Question 11

MHRA interactions with warfarin

Answer 11

Tramadol - increases INR

Miconazole - OTC daktarinboral gel - increases INR

Question 12

Interactions warfarin

Answer 12

Cranberry juice increases INR
CYP450s
Vit K rich foods - leafy greens reduce efficacy of warfarin avoid major diet changes

Question 13

INR target for minor surgery with low risk of bleeding

When to restart

Answer 13

<2.5
Then restart within 24 hrs of surgery

Question 14

Warfarin plan for procesures with risk of severe bleeding

Answer 14

STOP warfarin 3-5 days before
But bridge with LMWH
STOP LMWH 24hrs before surgery
Then restart LMWH 48hrs after surgery

Give VitK if INR is >1.5 day before surgery

Question 15

Name doacs

Answer 15

Apixaban
Dabigatran
Edoxaban
Rivaroxaban

Question 16

What does apixaban, edoxaban and rivaroxaban act on

Answer 16

Direct transversie inhibitors of factor Xa

Question 17

What does dabigatran act on

Answer 17

Reversible inhibitor of free thrombin

Question 18

MHRA for doacs

Answer 18

Paediatric formulations, dose adjustments in renal impairment

Increased Doac toxicity in these groups

Question 19

Apixaban dose prophylaxis stroke and systemic emobilism in non valbular AF

Answer 19

5mg BD

Question 20

Apixaban when to reduce dose and what to in prophylaxis of stroke and systemic embolism in non valvular AF

Answer 20

2.5mg BD

ATLEAST 2 of following:
80+
Less than 60kg
Creat 133+
Crcl 15-29

Question 21

Apixaban antidote

Answer 21

Andexanet alfa

Question 22

Edoxaban dosing for prophylaxis stroke…

Answer 22

60mg OD

Question 23

Edoxaban when to reduce dose and what to in prophylaxis stroke…

Answer 23

30mg OD

less than 60kg
Crcl 15-50

Question 24

Rivaroxaban dosing prophylaxis stroke… Monotherapy

And in combo with aspi/clop

Answer 24

20mg OD

2-5mg BD

Question 25

Rivaroxaban when to reduce and what to

Answer 25

15mg OD instead of 20mg OD Crcl 15-49

Question 26

Administration advice with rivaroxaban

Answer 26

Must be taken with or after food

Question 27

Dabigatran dosing for prophylaxis of stroke ...

Answer 27

150mg BD

Question 28

Dabigatran when to reduce dose ranges

Answer 28

150mg OD instead of 220mg OD in hip/knee surgery 110-150mg BD instead of 150mg BD for others 110mg for 80+ 75-79 years Crcl 30-50 High bleeding risk

Question 29

Antidote for dabigatran

Answer 29

Idarucizumab

Question 30

What are the parenteral anticoagulants

Answer 30

Heparin Bemiparin Dalteparin Enoxaparin Tinzaparin

Question 31

Why is unfractioned heparin used what to monitor

Answer 31

Quick initiation and elimination so good for quick control and termination Monitor APTT levels

Question 32

Why use LMWHs

Answer 32

Lower risk of heparin induced thrombocytopenia Longer duration of action Preferred in pregnancy

Question 33

What is antidote for haemorrhage in heparins

Answer 33

Protamine sulphate

Question 34

Aspirin comtraindications

Answer 34

Less than 16yrs due to Reyes syndrome UNLESS indicated for kawasakis disease Patients with hypersensitivity to salicylates and NSAIDs

Question 35

Aspirin has what interaction with a high risk drug

Answer 35

Mtx Increases mtx toxicity