Cardio (from e-learning) Flashcards
What are the advantages of DOACs over warfarin?
- wide therepeutic window (no need for routine anticoag monitoring)
- rapid onset of action (no need for initial tx with parenteral anticoag)
- predictable anticoag effect
- absence of food interactions
what should be offered first line for pts with confirmed DVT/PE?
DOAC
Elderly pt with new diagnosis of AF - what is your loading dose of warfarin?
Can be as low as 1mg daily
Pt on warfarin has INR 5.0 (target: 2.5). What do you do?
Omit dose for 1 day, then recheck INR
Pt on warfarin has INR 8.0 with no major bleeding. What do you do?
Administer low dose of phytomenadione (less than 5mg)
Duration of anticoag therapy for heart valves, VTE tx, A.Fib, VTE prevention
Mechanical valve: life-long
Tissue valve: short duration
provoked VTE tx: at least 3 months
unprovoked VTE tx: at least 3 months, consider lifelong
A.fib: lifelong anticoag (use CHADVASC and ORBIT to guide)
VTE prevention: hip/knee surgery req anticoag for 4 weeks, or for period lower limb is immobilised, pts at risk of vte may be offered anticoag during pregnancy/after birth
Tx of UA/NSTEMI in pts in whom urgent PCI is not indicated
Fondaparinux
Warfarin is C/I in which trimestered of pregnancy
1st and 3rd
What is normal INR range? What is target INR range in Pts with thrombogenic conditions?
normal: 0.8-1.2
target: 2.0-3.0
Pts prescribed VKAs should have
yellow anticoagulant record bok
How to manage a raised INR result?
- Omit VKA dose/reduce VKA dose
- Reverse anticoagulation if clinically indicated (phytomenadione)
- Investigate cause
When/how should you do emergency anticoagulation reversal?
If pt has MAJOR bleeding
25-50 units of prothrombin complex concentrate (like Beriplex) + 5-10mg IV vit k
Which genetic variations have the biggest effect on pt’s warfarin tolerance?
Variations in CYP2C9 and VKORC1
most appropriate loading dose regimen for pt with acute unprovoked DVT?
10mg on day1, and day2, followed by INR check on day 3
