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CACP Review > CACP Domain 2 Indications and Recommendations > Flashcards

CACP Domain 2 Indications and Recommendations Flashcards

1
Q

Which anticoagulant is used to treat peripheral arterial embolism?

A

UFH

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2
Q

Which DOAC is used to treat acutely ill medical patients?

A

Rivaroxaban

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3
Q

Which anticoagulant is used in ECMO, blood transfusions, and dialysis procedures?

A

UFH

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4
Q

Which anticoagulant is used to treat DIC?

A

UFH

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5
Q

Which anticoagulants are used for prophylaxis of DVT in abdominal surgery?

A

Enoxaparin and Fondaparinux

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6
Q

Can enoxaparin be used for the outpatient treatment of acute DVT with PE?

A

No, only for outpatient treatment without PE

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7
Q

Which anticoagulant is used for DVT prophylaxis in hip fracture surgery?

A

Fondaparinux only

(Rivaroxaban, Apixaban, Dabigatran, Enoxaparin, and Fondaparinux are used as DVT prophylaxis for hip replacement surgery.)

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8
Q

When can fondaparinux be used to treat DVT or PE?

A

When it is given in conjunction with warfarin

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9
Q

When can prasugrel be used to treat STEMI?

A

When used with PCI

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10
Q

When can tirofiban be used?

A

Only in non-ST elevated ACS (UA and NSTEMI)

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11
Q

Thrombolytics are approved for the treatment of

A

Acute myocardial infarction, acute ischemic stroke, acute massive PE (alteplase only)

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12
Q

AHA/ACC/HRS 2019 recommendation for AF, CHA2DS2-VASC score of 2 in men, 3 in women, with CrCl < 15 mL/min or on dialysis

A

Warfarin or Apixaban (2b recommendation)

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13
Q

Duration of anticoagulation for cardioversion for patients with AF/atrial flutter not < 48 hours (AHA/ACC/HRS 2019)

A

3 weeks before and 4 weeks after cardioversion at least

If having to start immediately due to hemodynamic instability, then continue for at least 4 weeks

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14
Q

ACS - underwent PCI with stent - AF with CHA2DS2-VASc 2+ - now on triple therapy - which P2Y12 inhibitor?

A

Clopidogrel preferred to prasugrel

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15
Q

ACS - underwent PCI with stent - AF with CHA2DS2-VASc 2+: triple or double therapy?

A

Double therapy (clopidogrel or ticagrelor + warfarin) preferred

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16
Q

ACS - underwent PCI with stent - AF with CHA2DS2-VASc 2+: what double therapy with DOACs is reasonable?

A

Clopidogrel with
Rivaroxaban 15 mg daily OR
Dabigatran 150 mg BID
(can consider dabigatran 110 mg BID if bleeding risk is high)

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17
Q

ACS - PCI with stent - AF with CHA2DS2-VASc 2+ on triple therapy, when can transition to double therapy be considered?

A

At 4 - 6 weeks

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18
Q

INR goal of 3.0 for warfarin patients with what indications

A

mechanical MVR, older generation mechanical AVR, mechanical AVR with risk factors (AF, previous VTE, LV dysfunction, or hypercoagulable conditions)

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19
Q

When to use ASA and what dose for valvular heart disease

A

ASA 81 mg daily in conjunction with warfarin for mechanical valve (recommended) or bioprosthetic valve (reasonable)

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20
Q

When does Chest 2017 for valvular heart disease recommend INR goal 1.5 - 2.0?

A

Mechanical On-X AVR and no VTE risk factors

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21
Q

Chest 2017 TAVR recommendation

A

Clopidogrel 75 mg daily + ASA 81 mg daily first 6 months, then ASA 81 mg daily lifelong

Anticoagulation with warfarin is reasonable for 3 months and low risk of bleeding

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22
Q

Anticoagulant of choice if patient also takes PGP inhibitors or inducers

A

Warfarin or Enoxaparin

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23
Q

Anticoagulant of choice if patient also takes strong CYP inhibitors or inducers

A

Warfarin or Enoxaparin

24
Q

When does ASH 2018 suggest against using anti-Xa monitoring for LMWH?

A

CrCl < 30 mL/min or obesity

25
Q

Duration of anticoagulation therapy for first unprovoked VTE with low or moderate bleeding risk

A

Indefinite (extended)

26
Q

Duration of anticoagulation therapy for first unprovoked VTE with high bleeding risk

A

3 months

27
Q

CHEST 2016 recommendation if stopping anticoagulant therapy for unprovoked proximal VTE

A

ASA 81 mg daily for long term VTE prophylaxis

28
Q

Should compression stockings be routinely used in acute DVT to prevent post-thrombotic syndrome?

A

No

29
Q

Chest 2016 recommendation for subsegmental PE (no DVT) and low risk of VTE recurrence

A

No anticoagulation

30
Q

Chest 2016 recommendation for massive PE (acute PE with hypotension)

A

Thrombolytic therapy, specifically systemic thrombolytic therapy

31
Q

Chest 2016 recommendations for recurrent VTE (2)

A

Switch to LMWH if taking warfarin or DOAC

Increase LMWH dose if taking LMWH

32
Q

Antiplatelet of choice with aspirin for elective surgery PCI

A

Clopidogrel

33
Q

Antiplatelet of choice with aspirin for ACS

A

Ticagrelor or Prasugrel

34
Q

If warfarin is chosen for antithrombotic management post-PCI, what is the INR goal range with triple anticoagulant therapy?

A

2.0 - 2.5

35
Q

Duration of oral anticoagulation post-PCI

A

Lifelong

36
Q

Patients on DOAC going for elective or nonemergent procedure should withhold anticoagulation therapy for

A

24 hours (48 hours if impaired renal function and taking dabigatran)

37
Q

Anticoagulation therapy for stable, non-invasive CAD, no AF

A

ASA or

ASA + rivaroxaban

38
Q

Anticoagulation therapy for stable, invasive CAD, no AF

A

ASA + P2Y12 inhibitor or

ASA + P2Y12 inhibitor + rivaroxaban

39
Q

Anticoagulation therapy for ACS (noninvasive or invasive), no AF

A

ASA + P2Y12 inhibitor or

ASA + P2Y12 inhibitor + rivaroxaban

40
Q

Anticoagulation therapy for stable, non-invasive CAD, with AF

A

ASA + any DOAC

41
Q

Anticoagulation therapy for stable, invasive CAD, with AF

A

ASA + P2Y12 inhibitor + Dabigatran or Rivaroxaban

42
Q

Anticoagulation therapy for ACS (noninvasive or invasive), with AF

A

ASA + P2Y12 inhibitor + Dabigatran or Rivaroxaban

43
Q

Cangrelor (Kengreal) FDA approved indication and dosing

A

30 mcg/kg prior to PCI, then 4 mcg/kg/min IV for 2 hours or duration of procedure, whichever is Longer to reduce risk of periprocedural MI, repeat coronary vascularization, and stent thrombosis in patients who have Not been treated with a P2Y12 inhibitor (do not use clopidogrel or prasugrel during cangrelor infusion) and are not being given GP2b/3a inhibitor

44
Q

ASH 2020 for DVT/PE: if VTE is provoked by a transient risk factor and patient has a history of another VTE provoked by a transient risk factor, what is duration of therapy for this transient risk factor?

A

Primary treatment of 3 - 6 months only (instead of indefinite)

45
Q

Does ASH recommend the routine use of compression stockings in a patient with PTS?

A

No, ASH recommends against the routine use as many patients may not benefit from it

46
Q

If a patient with a mechanical heart valve is undergoing a procedure that requires warfarin interruption, do you always bridge?

A

Yes, always bridge for mechanical heart valve if warfarin is needing to be held

47
Q

Acute ischemic stroke (not mild, nondisabling or acute stroke or head trauma or intracranial/spinal surgery within 3 months or who have received full treatment LMWH) within 4.5 hours, first drug and dose of choice?

A

IV alteplase 0.9 mg/kg (max dose 90 mg), 10% given over the first minute, the rest given over the remaining 50 mins

48
Q

Should you give a GP2b3a inhibitor concurrently with IV alteplase?

A

No

49
Q

If a patient has been given a fibrinolytic, when to give ASA?

A

Avoid within the first 90 mins, generally delayed until 24 hours later

50
Q

When to start DAPT if minor noncardioembolic ischemic stroke and did not receive IV alteplase? How long to continue?

A

Within 24 hours after symptom onset, continue for 21 days and up to 90 days

51
Q

Recommended antithrombotic therapy for mechanical valve patients

A

VKA + ASA 81 mg daily lifelong

52
Q

Reasonable antithrombotic therapy for bioprosthetic valve patients (drug and duration)

A

VKA + ASA 81 mg daily
OR
DOAC + ASA 81 mg daily

Duration 3 - 6 months, then ASA 81 mg daily lifelong

53
Q

Reasonable antithrombotic therapy for TAVR

A 
VKA (at least 3 months if low bleeding risk)
\+
Clopidogrel 75 mg daily (first 6 months)
\+
ASA 81 mg daily lifelong
54
Q

If bileaflet mechanical AVR and no other risk factors for surgical thrombosis and patient is taking VKA and INR is subtherapeutic, do you bridge for invasive procedures?

A

No, interruption without bridging agents is recommended

55
Q

Recommended antithrombotic therapy for atherosclerotic lower extremity PAD

A

ASA 81 mg daily
+
Clopidogrel 75 mg daily

CACP Review (16 decks)

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