Pharm 6 Thrombi pt0 Anticoag Flowsheet Flashcards Preview

Pharmacology > Pharm 6 Thrombi pt0 Anticoag Flowsheet > Flashcards

Flashcards in Pharm 6 Thrombi pt0 Anticoag Flowsheet Deck (28)
1

First episode, transient risk factor
Target INR? Duration of Therapy?

2.0-3.0
3 months

2

First episode, idiopathic DVT
Target INR? Duration of Therapy?

2.0-3.0
6-12 months*
*: consider indefinite therapy

3

First episode, patient with cancer
Target INR? Duration of Therapy?

2.0-3.0
LMWH 3-6 months, then warfarin. Tx until cancer is resolved (indefinitely?)

4

First episode and single risk factor
Target INR? Duration of Therapy?

2.0-3.0
6-12 months

5

First episode, antiphospholipid antibodies or at least two risk factors
Target INR? Duration of Therapy?

2.0-3.0
12 months (indefinitely?)

6

Recurrent DVT
Target INR? Duration of Therapy?

2.0-3.0
Indefinitely

7

A fib
Target INR? Duration of Therapy?

2.0-3.0
Indefinitely

8

Rheumatic mitral valve and atrial fibrillation or previous emboli
Target INR? Duration of Therapy?

2.0-3.0
Indefinitely

9

Rheumatic mitral valve disease, normal sinus rhythm, and left atrial
diameter > 5.5 cm
Target INR? Duration of Therapy?

2.0-3.0
Indefinitely

10

Aortic St. Jude Medical bileaflet valve
Target INR? Duration of Therapy?

2.0-3.0
Indefinitely

11

Mitral tilting disk valves and bileaflet mechanical valves
Target INR? Duration of Therapy?

2.5-3.5
Indefinitely

12

Aortic CarboMedics bileaflet or Medtronic Hall tilting disk valves,
normal sinus rhythm, and no LAE
Target INR? Duration of Therapy?

2.0-3.0
Indefinitely

13

Mechanical valves with risk factors (atrial fibrillation, myocardial
infarction, LAE, endocardial damage, low ejection fraction)
Target INR? Duration of Therapy?

2.5-3.5
Indefinitely, low dose aspirin

14

Caged ball or disk valve
Target INR? Duration of Therapy?

2.5-3.5
Indefinitely, low dose aspirin

15

Mechanical valve with breakthrough embolism despite INR 2.0 to 3.0
Target INR? Duration of Therapy?

2.5-3.5
Indefinitely, low dose aspirin

16

Bioprosthetic valve (mitral)
Target INR? Duration of Therapy?

2.0-3.0
3 months after placement

17

Bioprosthetic valve (aortic)
Target INR? Duration of Therapy?

2.0-3.0
3 months of warfarin or aspirin

18

Patient has INR 5.0 to 8.9, no significant bleeding. How do you manage?

Omit 1 to 2 doses; reduce dose 10 to 20 percent; monitor frequently.
Alternatively: Vit K1 PO

19

Patient has INR >9, no significant bleeding. How do you manage?

Hold warfarin therapy; give vitamin K1 5 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic

20

Patient has serious bleeding (any INR). How do you manage?

Hold warfarin; give vitamin K1 10 mg slow intravenous (IV) plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed

21

Life-threatening bleeding, any INR
How do you manage?

Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternate) supplemented
with vitamin K1 (10 mg slow IV); repeat as needed.

22

INR <1.5 (no bleeding)
Dose adjusting, when take next INR?

Adjust: increase dose 10-20%, consider extra dose
Next INR: 4-8 days

23

INR 1.5-1.9 (target is 2.0-3.0 no bleeding)
or INR 1.5-2.4 (target is 2.5-3.5, no bleeding)
Dose adjusting, when take next INR?

Adjust: Increase dose 5-10%
Next INR: 7-14 days

24

INR 2.0-3.0 (target is 2.0-3.0, no bleeding)
or INR 2.5-3.5 (target is 2.5-3.5, no bleeding)
Dose adjusting, when take next INR?

No change
Number of consecutive in-range INRs x 1 week (max 4 weeks)
For example, if a patient has had three consecutive in-range INR values, recheck in 3 weeks.

25

INR 3.1-3.9 (target is 2.0-3.0, no bleeding)
Dose adjusting, when take next INR?

Decrease dose 5-10%
7 to 14 days

26

INR 3.6-4.5 (target is 2.5-3.5, no bleeding)
Dose adjusting, when take next INR?

Decrease dose 5-10% consider holding one dose
7 to 14 days

27

INR 4.0-4.9 (target is 2.0-3.0, no bleeding)
Dose adjusting, when take next INR?

Hold for 0-1 day then decrease dose 10%a
4-8 days

28

INR 4.5-6.0 (target is 2.5-3.5, no bleeding)
Dose adjusting, when take next INR?

Hold for 1-2 days, then decrease dose 5-15%
2-8 days