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AmCare Exam 3 > NOAGs + Disease > Flashcards

NOAGs + Disease Flashcards

1
Q

CHADS2

A 
	Congestive Heart Failure
	Hypertension
	Age ≥ 75 years
	Diabetes mellitus
	Prior stroke/TIA/thromboembolism
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2
Q

CHADS2 > 2 =

A

High risk
Oral anticoag
Dabigatran 150 mg BID preferred over warfarin

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3
Q

CHADS2 = 1 =

A

Intermediate Risk

Oral anticoagulant recommended over aspirn

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4
Q

CHADS2 = 0 =

A

Low Risk

Can consider ASA 81 mg

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5
Q

CHA2DS2-VASc

A 
	Congestive Heart Failure
	Hypertension
	Age ≥ 75 years (2)
	Diabetes mellitus
	Prior stroke/TIA/thromboembolism (2)
	Vascular disease (MI, PAD, aortic plaque)
	Age 65-74 years
	Sex (category) - female
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6
Q

CHA2DS2-VASc >/= 2 =

A

Oral anticoagulant therapy recommended

Warfarin (A), then dabigatran, rivaroxaban, apixaban (B)

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7
Q

CHA2DS2-VASc = 1 =

A

None

Consider ASA

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8
Q

CHA2DS2-VASc = 0 =

A

None

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9
Q

RE-LY Trial for A Fib

A
  • Dabigatran is SUPERIOR to warfarin
  • More GI bleeding with dabigatran
  • More intracranial bleeding with warfarin
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10
Q

ROCKET AF Trial for A Fib

A
  • Rivaroxaban is NON-INFERIOR to warfarin
  • More GI bleeding with rivaroxaban
  • More intracranial hemorrhage with warfarin
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11
Q

ARISTOLE Trial for A Fib

A
  • Apixaban is SUPERIOR to warfarin
  • More major bleeding with warfarin
  • Less risk of intracranila bleed with apixaban
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12
Q

ENGAGE Trial for A Fib

A
  • Edoxaban is NON-INFERIOR to warfarin
  • More majro bleed with warfarin
  • Less risk of intracranila bleed with edoxaban
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13
Q

Recover Trial for DVT/PE

A
  • Dabigatran is equal to warfarin

* Similar bleed risk

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14
Q

EINSTEIN Trial for DVT/PE

A
  • Rivaroxaban is NON-INFERIOR to warfarin

* Same bleed risk in DVT and less bleed with R in PE

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15
Q

AMPLIFY Trial for DVT/PE

A
  • Apixaban is NON-INFERIOR to warfarin/LMWH

* Apixaban had a 69% decrease in bleeds

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16
Q

Hokusai-VTE Trial for DVT/PE

A
  • Edoxaban is NON-INFERIOR to warfarin

* Higher rate of bleed with warfarin

17
Q

AMPLIFY-ETC Trial for DVT/PE

A

o Extended Use of TSOACs in VTE Management

o No increase in major bleed with apixaban

18
Q

EINSTEIN-Extension Trial for DVT/PE

A

o Extended Use of TSOACs in VTE Management

o No increase risk for major bleed but higher risk of non-major bleed with rivaroxaban

19
Q

RE-MEDY Trial for DVT/PE

A

o Extended Use of TSOACs in VTE Management

o Lower bleed events with dabigatran

20
Q

Coagulation Cascade

A

Plaque rupture → activation of coagulation cascade →release of tissue factor → activation of factor X → prothrombin is convert to thrombin → conversion of fibrinogen to fibrin → thrombus formation

21
Q

APPRAISE-2 Trial for ACS

A
  • Apixaban vs aspirin + clopidogrel
  • Stopped early because of bleed
  • Risks do not outweigh benefits
22
Q

ATLAS ACS 2 TIMI 51

A
  • Rivaroxaban vs aspirin + thienopyridine
  • Decreased CV death, MI or stroke
  • Less bleeding than with apixaban but still increased risk of major bleeding
23
Q

Warfarin VS Newer Agents

A

W: cheap, can check blood levels, reversible with vit K, years of clinical experience, slow onset, no need for renal dose adjustment
NOAGs: very costly, little clinical experience, no monitoring, no anecdote, rapid onset, fewer drug interactions, MUST renal dose adjust

24
Q

If patient is already on warfarin…

A

 Well managed with goal INR 2-3 then continue warfarin

 Not well managed then consider another oral anticoagulant

25
Q

If patient is NOT already on warfarin…

A

 If patient has poor compliance then warfarin may not be good choice
 If patient has good compliance then warfarin or another oral anticoagulant

26
Q

Mild Renal Impairment > 50 mL/min

A

Dabigatrain, rivaroxaban, edoxaban or apixaban

27
Q

Moderate Renal Impairment 30-50 mL/min

A

Dabigatrain, rivaroxaban, edoxaban or apixaban WITH DOSE ADJUSTMENTS

28
Q

Severe Renal Impairment Less than 30 mL/min

A

Warfarin but still could dose adjust rivaroxaban, edoxaban or apixaban

29
Q

If on dialysis then…

A

Warfarin is only option

AmCare Exam 3 (7 decks)

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