DOAC

Question 1

Which anticoagulants are DOACs

Answer 1

Apixaban

Dabigatran

Edoxaban

Rivaroxaban

Betrixaban

Question 2

By what mechanisms are DOACs eliminated

Answer 2

renally

Question 3

Which has the shortest half life and achieves steady state quicker

Answer 3

Rivaroxaban

Question 4

Most have what common side effect

Answer 4

Bleeding

Question 5

Which has dyspepsia

Answer 5

Dabigatran

Question 6

Which has the longest half life

Answer 6

Dabigatran

Question 7

Which achieve steady state 2-3 days

Answer 7

Dabigatran

Apixaban

Edoxaban

Question 8

Which are used when considering switching from heparin, LMWH and fondaparinux after days of initiation

Answer 8

Dabigatran and Edoxaban

Question 9

Which should be taking with food if dose is ≥15 mg

Answer 9

Rivaroxaban

Question 10

Which can be used for treatment of VTE

Answer 10

Apixaban and rivaroxaban

Question 11

What is the dosing of Dabigatran when used as maintenance

Answer 11

150 mg BID

Question 12

What’s the dosing of Edoxaban when used as maintenance

Answer 12

60 mg daily

Question 13

What is the dosing of Apixaban

Answer 13

10 mg BID for the first 7 days

Switch to 5 mg BID

Question 14

If patient has recurrent VTE and low risk what dose Of Apixaban should be administered

Answer 14

2.5 mg BID

Question 15

What is the dose of rivaroxaban

Answer 15

15 mg BID for 21 days

Switch to 20 mg daily with food

Question 16

A patient presents to your clinic and has a BMI >40kg or TBW > 120 kg which DOAC is not appropriate

Answer 16

Dabigatran

Rivaroxaban

Apixaban

Edoxaban

Question 17

A patient presents to your clinic with a TBW < 60 kg what dose of Edoxaban should be administered

Answer 17

30 mg with food

Question 18

A patient present at your mini with a CrCl < 30 ml/min what DOAC should be avoided

Answer 18

Dabigatran

Rivaroxaban

Apixaban

Question 19

Two patient present to your clinic:

Patient A has CrCl between 15-30 ml/min

Patient B has a CrCL less than 15 ml/min

How should both patient be dosed with edoxaban

Answer 19

Patient A: administer 30 mg with food

Patient B: avoid Edoxaban

Question 20

When considering switching from a warfarin to a DOAC what are the target INR

Answer 20

Dabigatran < 2.0

Rivaroxaban < 3.0

Apixaban < 2.0

Edoxaban <2.5

Question 21

What should patient do if Dabigatran dose is missed

Answer 21

Take ASAP but 6 hours before the next dose

Question 22

What should a patient do if 15mg rivaroxaban dose is missed

Answer 22

Take 30 mg dose

Question 23

What should a patient do if Apixaban and Edoxaban doses are missed

Answer 23

Take ASAP

Question 24

When switching from DOAC to warfarin what should INR value be

Answer 24

> 2.0

Question 25

What is the antidote for Dabigatran

Answer 25

Idarucizumab (5 grams IV): 2.5 g infused 15 mins apart

Question 26

What's factor Xa antidote (Apixaban and rivaroxaban)

Answer 26

Andexanet alpha

Question 27

When is bridging considered for VTE patients

Answer 27

When patient is at high risk: Recurrent VTE < 3 months: ``` Protein S deficiency Protein C deficiency Homozygous Factor V Leiden or prothrombin gene mutation Antithrombin Ill deficiency Antiphospholipid syndrome ```

Question 28

What is perioperative management VKA Anticoagulation

Answer 28

Stop warfarin 5 days prior to surgery Initiate LMWH for moderate to high risk patient Stop LMWH 24 hours prior to procedure Last dose should be half a dose Restart warfarin 12-24 hours after Restart LMWH 48-72 hours after

Question 29

For DOACs timing of last dose prior to surgery is dependent on what factor

Answer 29

Creatinine clearance

Question 30

Which form of anticoagulant should not be used in bridging

Answer 30

Parenteral but restart 24-72h after surgery depending on bleeding risk

Question 31

For patient with VTE and liver disease or pregnant what is the preferred anticoagulant

Answer 31

LMWH

Question 32

For patient with VTE and cancer what is the preferred anticoagulant

Answer 32

LMWH and DOAC