blood thinners overview

Question 1

Atrial fibraillation blood thinner management overview

Answer 1

+Rate and rhythm control
1. CHA2DS2VASC + HASBLED
2. DOACS if non valvular
dabigatran for crcl >30
apixaban >25
rivaroxaban >15

If valvular (rheumatic MS or/and mechanical valve) - warfarin

Question 2

heart vavles blood thinner management overview

Answer 2

Mechanical valve - on lifelong: warfarin +/- aspirin (if concurrent atherosclerosis or thrombosis despite warfarin)

Tissue valve - aortic = warfarin/aspirin for 3mo
- mitral = warfarin for 3mo

Question 3

TIA blood thinner management overview

Answer 3

+statin +BP control
ABCD2 Score
1. Aspirin or clopidogrel or dipyramidol

Question 4

stroke blood thinner management overview

Answer 4

1. IV thrombolysis within 4.5hours onset -> alteplase
2. aspirin

Long term: Antiplatelts: aspirin or clopidogrel or dipyramidole -> if have AF give NOAC
BP control
Statins

Question 5

STEMI blood thinner management overview

Answer 5

Acute: 1. aspirin +morphin +GTN + oxygen
2. PZY12I - if having thrombolysis = clopidogrel +LMWh
- If having PCI = ticagrelor

Long term: Betablocker, ACE/ARB, statin
LMWH for 3-4weeks
Antiplatelt for 12mo
Aspirin lifelong

Question 6

NSTEMI blood thinner management overview

Answer 6

Acute: 1. aspirin +morphin +GTN + oxygen
Low risk = P2Y12I - increased bleeding risk: clopidogrel
- decreased bleeding risk: ticagrelor
Moderate to high risk and having angiography = ticagrelor +LMWH
Moderate to high risk and angiography delayed = gpIIb/IIai + LMWH

Question 7

Prophylactic agents for VTE

Answer 7

Parenteral anticoags
1. LMWH - dalteparin, enoxaparin - safer, more effective, decreased risk of HIT
2. UFH - for severe kidney impairment when rapid reversal is needed
3. Fondaparinux (Xai) - for major ortho or abdo surg. For pts with hx of HITS
4. DOACS - ppx post total hip or knee replacement

Question 8

VTE treatment

Answer 8

1. DOACS - apixaban, rivaroxaban, dabigatran
2. warfarin - if severe kidney impairment
3. parenteral anticoags (UFH, LMWH) if pregnant or breastfeeding, severe kidney impairment, decompensated cirrhosis

Duration: proximal unprovoked or ass with transient RF or active ca = 3-6mo
proximal caused by major surg/trauma that is no longer present = 3mo
Distal unprovoked = 3mo
Distal, transient provokign factor = 6weeks