More Guidelines

Question 1

In patients requiring Vitamin K antagonists before surgery it should be stopped

Answer 1

5 days prior to surgery

Question 2

In patients with mechanical valves, atrial fibrillation, or at high risk of VTE in regards to bridging

Answer 2

Bridging anticoagulation is recommended

Question 3

Low risk VTE patients and bridging

Answer 3

No bridging indicated

Question 4

dental procedure and vitamin K antagonists

Answer 4

Continue them with coadminstration of prohemostatic agent or stop 2-3 days before procedure

Question 5

In mod-high risk patients taking ASA requiring non-cardiac surgery

Answer 5

continue ASA

Question 6

In patients with a bare metal stent or drug eluding stent must wait how long before surgery

Answer 6

More than 6 weeks for bare metal

More than 6 months for drug-eluding

Question 7

If surgery is indicated and time is less than that indicated for stents, what to do with anticoagulants

Answer 7

continue dual antiplatelet therapy perioperatively

Question 8

When to restart vitamin K antagonists if stopped prior to surgery

Answer 8

12 to 24 hours after surgery and adequate hemostasis

Question 9

In patients with derm procedures Vitamin K antagonists should be

Answer 9

continued perioperatively

Question 10

In patients at low risk for CV events who are taking ASA anticipating surgery

Answer 10

stop 7-10 days prior to surgery

Question 11

ASA and clopidogrel/prasugrel in regards to CABG

Answer 11

continue ASA

stop clopidogrel/prasugrel 5 days prior

Question 12

Patients receiving heparin infusion in regards to anticipated surgery

Answer 12

stop 4-6 hours prior to surgery

Question 13

Dosing of LMWH in regards to anticipated surgery

Answer 13

last dose should be administered 24 hours prior to surgery

Not 12 hours

Question 14

Patients at high risk of bleeding surgery and resuming LMWH postoperatively

Answer 14

resume 48-72 hours after surgery

Question 15

Increased risk of bleeding surgeries

Answer 15

Urologic
PPM/ICD placement
Colonic polyp resection
High vascularized organs (spleen, kidney, liver)
bowel resection
Cardiac, spinal, cranial surgery

Question 16

Healthy outpatient regimen for starting VKA (warfarin)

Answer 16

10 mg for first 2 days

Question 17

Recommendations are _____ routine use of pharmacogenetic testing for guiding doses of VKA

Answer 17

against

Question 18

Patient with acute VTE should start VKA when

Answer 18

day 1-2 of LMWH or UFH

Question 19

For patients with stable INR, lab testing frequency

Answer 19

every 12 weeks

Question 20

For patient with stable INR with single out of range INR less than 0.5 above/below range

Answer 20

continue current dose and recheck in 1-2 weeks

Question 21

In patients with stable INR with single sub therapeutic INR

Answer 21

do not give bridging therapy

Question 22

Patients taking VKA should _____ use vitamin K supplementation

Answer 22

not

Question 23

Best practice of providers managing patients on Warfarin

Answer 23

1. systematic and coordinated fashion
2. patient education
3. systematic INR testing
4. tracking
5. follow-up
6. good patient communication of results and dosing decisions

Question 24

Patients who can demonstrate competency in self-management with VKA

Answer 24

should be allowed to do so without usual outpatient monitoring

Question 25

When deciding dosages for VKA use

Answer 25

nomograms

Question 26

Patients taking VKA should avoid what meds due to drug interactions

Answer 26

``` NSAIDs ASA Clopidogrel Cephalexin cefradine Cephalosporins Metronidazole Ciprofloxacin Levofloxacin Norfloxacin Amoxicillin Augmentin Fluconazole SSRI Co-Enzyme 10 3 G (ginko biloba, ginseng, garlic) ```

Question 27

Therapeutic range for VKA

Answer 27

INR 2-3

Question 28

Patient who are able to discontinue to VKA should

Answer 28

abruptly discontinue | unnecessary to taper

Question 29

dose for UFH

Answer 29

bolus and maintenance are weight adjusted VTE bolus 80 units/kg maintenance 18 units/kg Cardiac or stroke 70 followed by 15 or 5000 units bolus followed by 1000 units/hr

Question 30

outpatient subq UFH dose

Answer 30

333 units/kg once then 250 units/kg without monitoring

Question 31

Patients with severe renal insufficiency (CrCl

Answer 31

decrease dose

Question 32

Patients over 100 kg on fodaparinux dose

Answer 32

increase from usual dose of 7.5 mg to 10 mg daily

Question 33

Supratherapeutic INR treatment

Answer 33

INR 4.5-10 no evidence of bleeding = no Vit K | INR over 10 with no evidence of bleeding= give Vit K

Question 34

Criterion of prediction for bleeding on VKA

Answer 34

Should NOT solely be judged on clinical prediction

Question 35

For patients with VKA-associated major bleed should be given

Answer 35

reversal with four-factor prothrombin complex concentrate (PCC) rather than plasma

Question 36

Use of Vitamin K as a reversal

Answer 36

should be used additionally with reversal coagulation factors

Question 37

management of purulent skin/soft tissue infection

Answer 37

I and D with culture and sensitivity Severe- Vancomycin to start until cultures return Moderate- Bactrim or doxycycline Mild- JUST I and D

Question 38

Management of Nonpurulent skin/soft tissue infection

Answer 38

Mild- oral abx, PCN VK or Cephalosporin Moderate- IV PCN, or IV cefazolin/ceftriaxone Severe- rule out necrotizing process Empiric- Vancomycin plus Zosyn; culture and narrow

Question 39

Systemic symptoms of open wound of surgical site infection

Answer 39

Fever more than 4 days after operation temp over 38 C WBC over 12K Erythema over 5 cm

Question 40

Management of open wound without systemic symptoms of surgical site infection

Answer 40

dressing changes WITHOUT antibiotics

Question 41

Management of open wound WITH systemic symptoms of surgical site infection

Answer 41

dressing changes with antibiotics clean wound, trunk, head, neck, extremity Cefazolin or Vancomycin until MRSA ruled out wound of perineum, GI tract, or female GU Cephalosporin plus Flagyl or Levofloxacin plus Flagyl or Carbapenem

Question 42

Fever in the first 48 hours from operation for surgical site infection

Answer 42

only treat if wound is draining, local signs of inflammation, and cultures are revealing then open and decried, start PCN and clindamycin