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cardiovascular- anticoagulation Flashcards

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1
Q

What is tranexamic acid used for and how does it work?

A

Prevents bleeding by inhibiting fibrinolysis

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2
Q

Why should patients on oral contraception use tranexamic acid in caution?

A

Risk of thrombosis

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3
Q

What is prothrombin complex used for and who is it contraindicated in?

A

Haemorrhage. patients with history of heparin induced thromboctopenia

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4
Q

What do you use to prevent ischaemic neurological defects following a subarachnoid haemorrhage?

A

nimodipine

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5
Q

What are the risks for VTE?

A

reduced mobility, obesity, malignant disease, history of VTE, thrombophilic disorders, over 60 years

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6
Q

What are the risks for bleeding?

A

acute stroke, thrombocytopenia, inherited bleeding disorders

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7
Q

What VTE prophylaxis is preferred in renal failure?

A

unfractionated heparin

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8
Q

What surgical patients can have fondaparinux?

A

hip/knee replacement, GI bariatric, day surgery

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9
Q

What surgery types can have DOACs after?

A

hip or knee replacement

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10
Q

How long should pharmacological prophylaxis continue post surgery?

A

5-7 days or until mobile

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11
Q

What surgery should have pharmacological prophylaxis extended to 28 days?

A

major cancer surgery in the abdomen or pelvis

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12
Q

How do you treat VTE?

A

Initially a LMWH/unfractionated heparin at the same time an oral anticoagulant. Continue heparin for at least 5 days and until the INR is >=2 for at least 24 hours.

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13
Q

How do you monitor heparin?

A

APTT

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14
Q

How do you manage VTE in pregnancy?

A

Heparins do not cross the placenta. LMWH are eliminated more rapidly in pregancy (BD dosing)

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15
Q

What reverses heparin?

A

Protamine

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16
Q

How do you initially manage a TIA?

A

immediately receive aspirin (if not tolerated give clopidogrel)

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17
Q

When should alteplase be administered?

A

within 4.5 hours of symptom onset of acute ischaemic stroke

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18
Q

When should aspirin be given in stroke management?

A

24 hours post thrombolysis. Within 48 hours of symptom onset in patients not receiving thrombolysis

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19
Q

Why shouldn’t you treat hypertension in the acute phase of ischaemic stroke?

A

Can reduce cerebral perfusion

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20
Q

What is the long term management following a TIA?

A

MR dipyridamole with aspirin. Intolerant to aspirin then just MR dipyridamole or aspirin if vice versa. Last option is clopidogrel

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21
Q

What is the long term management following an ischaemic stroke?

A

clopidogrel long term.
If contraindicated give MR dipyridamole in combo with aspirin.
If have AF then anticoagulate
Start statin 48 hours after stroke
Blood pressure following acute phase target <130/80- don’t start on beta blocker

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22
Q

Name 3 vitamin K antagonists?

A

warfarin, acenocoumarol, phenindione

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23
Q

How long does warfarin take to work?

A

48 to 72 hours

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24
Q

What is the target INR for treatment of DVT/PE and AF?

A

2.5

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25
What is the target INR for the recurrent DVT/PE and also mechanical heart valve?
3.5
26
How long should you anticoagulate someone with an isolated calf DVT?
6 weeks
27
How long should you anticogulate someone with a VTE provoked by transient risk factors?
at least 3 months
28
How do you control major bleeding?
stop warfarin, IV phytomenadione (vitamin K), dried prothrombin complex
29
How do you control minor bleeding with INR>8?
stop warfarin, IV phytomenadione (vitamin K), can repeat vit K if INR still high after 24 hours. Restart warfarin when INR<5
30
What do you do if INR>8 and no bleeding?
stop warfarin, give vitamin K orally using the IV preparation, can repeat vitamin K if INR still high after 24 hours
31
How do you control minor bleeding with INR 5-8?
stop warfarin, give vitamin K IV
32
What do you do if INR 5-8 with no bleeding?
hold 1 or 2 warfarin doses and reduce subsequent maintenance doses
33
How do you control warfarin before surgery?
stop 5 days before before elective surgery. Give Vit K the day before if INR >=1.5. If at high risk (VTE in last 3 months, AF with previous stroke/TIA, or mechanical heart valve) bridge with LMWH treatment dose.
34
How do antiplatelet drugs work?
Decrease platelet aggregation and inhibit thrombus formulation in arterial circulation (mainly platelets)
35
What do you need to control before you give aspirin?
Unduly high BP
36
Heparin
initiates anticoagulation rapidly. Has a short duration of action
37
Why are LMWH preferred?
Lower risk of heparin induced thrombocytopenia, does not require monitoring, duration of action longer
38
Name a Heparinoid and what it is used for?
Danaporoid. Used for prophylaxis of DVT in patients undergoing surgery. Role in HIT
39
What are the different doses of aspirin?
Secondary prevention: 75mg OD NSTEMI: initially 300mg then 75mg for 12 months STEMI: initially 300mg then 75mg for at least 4 weeks acute ischaemic stroke: 300mg for 14 days
40
What are the side effects of aspirin?
blood disorders, GI haemorrhage, increased bleeding time
41
Who is aspirin contraindicated in?
peptic ulcers, under 16, haemophilia
42
What are the different doses of clopidogrel?
Prevention in PCI: loading dose 300mg NSTEMI with aspirin: 300mg then 75mg for up to 12 months STEMI: 300mg then 75mg for at least 4 weeks
43
Name some factor 10a inhibitors?
Apixiban, fondiparinux, rivaroxaban
44
What are the different doses of apixiban?
VTE prophylaxis following TKR: 2.5mg BD for 10-14 days, starting 12-24 hours post surgery VTE prophylaxis following THR: 2.5mg BD for 32-38 days, starting 12-24 hours post surgery DVT/PE treatment: 10mg BD for 7 days, then 5mg BD Prophylaxis of recurrent DVTs: 2.5mg BD following completion of 6 months Prophylaxis in AF with 1 risk factor; under 80: 5mg BD, over 80: 2.5mg BD
45
What are the risk factors to allow use of DOAC?
Previous stroke or TIA, HF, age over 75, diabetes, HTM
46
What renal function should you avoid apixiban?
less than 15
47
What is fondiparinux used for?
VTE prophylaxis, treatment of unstable angina/NSTEMI/STEMI, VTE treatment CI in renal function less than 30
48
What are the different doses of rivaroxaban?
VTE prophylaxis following TKR: 10mg OD for 2 weeks, starting 6-10 hours post surgery. VTE prophylaxis following THR: 10mg OD for 5 weeks, starting 6-10 hours post surgery DVT treatment: 15mg BD 3 weeks, then 20mg OD Prophlyaxis in AF with 1 risk factor: 20mg OD Prophylaxis in ACS: 2.5mg BD for 12 months
49
When are heparins contraindicated?
acute bacterial endocarditis
50
What is a side effect of heparins?
osteoprosis
51
What is heparin induced thrombocytopenia, when does it develop and what are the signs of it?
immune mediated, develops after 5-10 days, | 30% reduction in platelet count, thrombosis or skin allergy.
52
Why do heparins cause hyperkalaemia?
inhibit aldosterone secretions
53
What monitoring is required for heparins?
Platelets before and after 4 days | Potassium before and regularly after
54
When should you be cautious with enoxaparin?
low body weight. Reduce dose if CrCl<30
55
Name 3 direct thrombin (2a) inhibitors
Agatroban, Bivalirudin, Dabigatran
56
What is the use of Agatroban?
anticoagulation in patients with type 2 HIT who require parenteral anticoagulation
57
How do you monitor Agatroban?
APTT 2 hours after start of treatment, then 2-4 hours after infusion rate altered, then OD
58
What renal function should you avoid rivaroxaban?
CrCl less than 15
59
What are the different doses of dabigatran?
- VTE prophylaxis TKR: <75yrs 110mg 1-4 hours post surgery, then 220mg OD for 9 days (12-24 hours after inital dose) >75yrs have 75mg and 150mg - VTE prophylaxis THR: 27-34 days - DVT treatment: <75 150mg BD following 5 days of parenteral treatment. 75-79 110-150mg BD, >80 110mg BD - AF: 110-150mg BD
60
What happens to the dose of dabigatran if patient is on verapamil or amiodarone?
second dose is 150mg. take dose at the same time as verpamil or amiodarone
61
What renal function should you avoid dabigatran?
less than 30
62
How often do you have to monitor renal function with dabigatran?
before starting and annually
63
Name a Tissue Plasminogen Acitvator
Urokinase (IV infusion)
64
What food interactions are there with warfarin?
major changes in diet and alcohol can affect control | avoid cranberry juic
65
can pregnant women have warfarin?
no- teratogen
66
what are side effects of warfarin?
hepatic dysfunction, jaundice, pancreatitis
67
What do you need monitor with warfarin?
baseline prothrombin time, INR daily/alternate days during early treatment, then longer intervals up to 12 weeks. Change in condition then increase monitoring
68
When should you avoid warfarin?
severe hepatic impairment. | Caution mild to moderation renal impairment. Monitor INR

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