How do you reverse warfarin?
Prothrombin X (25 units per Kg)
FFP (one bag)
What are some treatment options for PE?
What is the mechanism of action of rivaroxaban?
Inhibitor of factor 10a
What are some presenting symptoms of PE?
What are some options for prophylaxis?
Chemical prophylaxis - exonaparin
Mechanical - TEDS, intermittent pneumatic compression
What is the mechanism of action of clopidogrel?
Blocks the P2Y12 receptor on platelets that ADP binds to
What constitutes major surgery?
Abdominal surgery >45minutes
What are some risk factors?
What anticoagulation is required for stents?
- Life long aspirin
- 4 months clopridogrel
- Life long aspirin
- 12 months clopridogrel
What is the mechanism of action of heparin?
It activates antithrombin III causing inactivation of thrombin and factor 10a and hence reduced clotting
When do you use an IVC filter?
Patient with Hx of DVT/PE where anticoagulation is contraindicated
Does chemical prophylaxis increase the risk of bleeding in surgery?
Not for major bleeds
What is co-plavix?
Clopridogrel + aspirin
How does warfarin work?
Inhibits vitamin K reductase thereby blocking synthesis of vit K dependent clotting factors - 2,7,9, and 10
What is the mechanism of action of apixaban?
Factor 10a inhibitor
What is the mechanism of action of dabigitran?
Direct thrombin inhibitor
Why is laproscopic surgery higher risk for DVT?
How long do you place someone on prophylaxis?
5-7 days or until fully mobile
Extended prophylaxis for major pelvic surgery/in the setting of malignancy
What are some primary disease of hypercoagulation?
Factor V leiden
Protein C/S deficiency
What are the WELLS criteria? What is their purpose?
Symptoms of DVT (3pt)
Symptoms not attributable to another pathology (3pt)
Immobilisation (>3days) or surgery in prev four weeks (1.5pt)
Tachycard >100 (1.5pt)
PHx of DVT or PE (1.5pt)
Presence of haemoptysis (1pt)
Presence of malignancy (1pt)
To determine pretest probability when performing a CTPA - >6 is high risk and a CTPA can be performed without D-dimer