TVP E TEP

Question 1

QUAL O EFEITO COLATERAL DO USO PROLONGADO DA HNF

Answer 1

OSTEOPOROSE

OBS : HBPM TEM MENOR RISCO DE HIT E OSTEOPOROSE

Question 2

QUAL A DIFERENCA NO MECANISMO DE ACO DA HNF E DA HBPM

Answer 2

A HBPM INIBE PREFERENCIALMENTE O FATOR X

A HNF INIBE O FATOR II E X

Question 3

COMO AGE O FONDAPARINOUX

CITE VANTAGENS DE SEU USO

Answer 3

INIBE O FATOR XA VIA ANTITROMBINA
NAO SE LIGA A PROT PLASMATICAS COMO HNF

DESVANTAGENS > NAO PODE SER USADO DE INS RENAL CLCR<30 E NAO TEM AGENTE DE REVERSAO

Question 4

DOSE ANTICOAGULANTE DE HNF

Answer 4

BOLUS 80U/KG
MANUTENCAO 18U/KG/H
ALVO TTPA EQUIVALENTE AO NIVEL SERICO DE HEPARINA DE 0,3-0,7UI/ML DE ATIVIDADE ANTI-Xa

Question 5

VANTAGENS DA HNF

DESVANTAGENS

Answer 5

REVERSIBILIDADE
PODE SER USADA NA INS RENAL
MEIA VIDA É CURTA CASO HAJAM SANGRAMENTOS

DESVANTAGEM> HIT, MONITORIZACAO FREQUENTE

Question 6

DESVANTAGENS DA HBPM

Answer 6

REVERSAO APENAS PARCIAL COM PROTAMINA
TB TEM RISCO DE HITT
NAO IDEAL EM PACIENTES COM CLCR<30

Question 7

USO DA PROTAMINA NA ACO COM HBPM

Answer 7

1MG DE PROTAMINA PARA CADA 100U DE ANTI-Xa DE HBPM - maximo de 50mg
pode ser necessario associar PFC

Question 8

HAS- BLED

Answer 8

Hypertension – 1 point
•
Abnormal renal and/or hepatic function – 1 point each
•
Stroke – 1 point
•
Bleeding tendency/predisposition – 1 point
•
Labile INR on warfarin – 1 point
•
Elderly (age >65 years) – 1 point
•
Drugs (aspirin or NSAIDs) and/or alcohol – 1 point each

Question 9

MANEJO DE SANGRAMENTO POR USO DE WARFARIM OU NIVEL SUPRATERAPEUTICO

Answer 9

*Supratherapeutic to 5.0
SEM SANGRAMENTO
Lower the warfarin dose, or
Omit a dose of warfarin and resume warfarin at a lower dose when the INR is in therapeutic range, or
Maintain current dose if the INR is minimally supratherapeutic

• > 5.0 to 9.0
  SEM SANGRAMENTO
  Omit the next one to two doses of warfarin, monitor the INR more frequently, and resume warfarin at a lower dose when the INR is in the therapeutic range, or
  Omit a dose of warfarin and administer 1 to 2.5 mg oral vitamin K1

*>9.0
SEM SANGRAMENTO
Hold warfarin and administer 2.5 to 5 mg oral vitamin K1. Monitor the INR more frequently and administer more vitamin K1 as needed. Resume warfarin at a lower dose when the INR is in the therapeutic range.

• QUALQUER INR COM SANGRAMENTO GRAVE
  Hold warfarin and administer 10 mg vitamin K by slow intravenous infusion; administer a four-factor prothrombin complex concentrate (4-factor PCC), or, if a PCC is not available, administer Fresh Frozen Plasma (FFP), depending on clinical urgency. Monitor and repeat as needed.