VTE

Question 1

UFH dose for VTE prophylaxis

Answer 1

5000 units sq q8h

Question 2

UFH contraindications

Answer 2

history of HIT

Question 3

when is UFH preferred

Answer 3

its lack of renal clearance makes it ideal for patients with AKI or CrCL <30 mL/min

Question 4

enoxaparin dose for VTE prophylaxis

Answer 4

40 mg sq q24h or 30 mg sq q12h

Question 5

renal dose adjustment enoxaparin for VTE prophylaxis

Answer 5

30 mg sq q24h

Question 6

enoxaparin contraindications

Answer 6

AKI, HIT

Question 7

dalteparin VTE prophylaxis dose

Answer 7

5000 units sq q24h

Question 8

dalteparin contraindications

Answer 8

AKI, HIT

Question 9

fondaparinux VTE prophylaxis dose

Answer 9

2.5 mg sq q24h

Question 10

fondaparinux contraindications

Answer 10

CrCL <30 mL/min

Question 11

when is fondaparinux preferred

Answer 11

patient with history of HIT

Question 12

apixaban VTE prophylaxis dose for total hip arthroplasty

Answer 12

2.5 mg bid x 35 days

Question 13

apixaban VTE prophylaxis dose for total knee arthroplasty

Answer 13

2.5 mg bid x 14 days

Question 14

dabigatran VTE prophylaxis dose for total hip arthroplasty

Answer 14

110 mg once, then 220 mg daily x 35 days

Question 15

rivaroxaban VTE prophylaxis dose in acute medical illness or total hip arthroplasty

Answer 15

10 mg daily x 35 days

Question 16

rivaroxaban VTE prophylaxis dose for total knee arthroplasty

Answer 16

10 mg daily x 14 days

Question 17

instances to avoid DOACs for VTE treatment

Answer 17

renal insufficiency, moderate to severe liver disease, significant drug-drug interactions (CYP3A4 inducers), CrCL < 30 mL/min)

Question 18

apixaban dose for VTE treatment

Answer 18

10 mg bid x 7 days, then 5 mg bid x 3-6 months

Question 19

dabigatran dose for VTE treatment

Answer 19

> 5 days of parenteral anticoagulation, then 150 mg bid x 3-6 months

Question 20

edoxaban dose for VTE treatment

Answer 20

> 5 days of parenteral anticoagulation, then 60 mg daily x 3-6 months

Question 21

rivaroxaban dose for VTE treatment

Answer 21

15 mg bid x 21 days, then 20 mg daily x 3-6 months

Question 22

which DOACs require parenteral anticoagulation first for VTE treatment

Answer 22

dabigatran and edoxaban

Question 23

UFH dose for VTE treatment

Answer 23

80 units/kg IV bolus, then 18 units/kg/hr initial rate titrated to aPTT or anti-Xa

Question 24

enoxaparin dose for VTE treatment

Answer 24

1 mg/kg q12h (reduced to q24h if CrCL<30 mL/min)

Question 25

dalteparin dose for VTE treatment

Answer 25

100 units/kg q12h

Question 26

fondaparinux dose for VTE treatment, <50 kg

Answer 26

5 mg daily

Question 27

fondaparinux dose for VTE treatment, 50-100 kg

Answer 27

7.5 mg daily

Question 28

fondaparinux dose for VTE treatment, >100 kg

Answer 28

10 mg daily

Question 29

which DOAC must be taken with food to facilitate absorption

Answer 29

rivaroxaban

Question 30

____ is the risk calculator used for medical patients

Answer 30

padua score

Question 31

____ is the risk calculator used for surgical patients

Answer 31

caprini score

Question 32

non-pharm VTE prophylaxis options

Answer 32

early ambulation, graduated compression stockings, intermittent pneumatic compression device, inferior vena cava (IVC) filters

Question 33

for high bleed risk patients, use ____ prophylaxis

Answer 33

mechanical

Question 34

when using pharm VTE prophylaxis, opt for ___

Answer 34

low dose

Question 35

for medical patients when pharm prophylaxis is used, ____ is preferred

Answer 35

LMWH

Question 36

for orthopedic surgery patients when pharm prophylaxis is used, _____ is preferred

Answer 36

DOAC

Question 37

for other major surgery patients when pharm prophylaxis is used, _____ is preferred

Answer 37

UFH or LMWH

Question 38

lab findings in DVT diagnosis

Answer 38

D-dimer elevation

Question 39

D-dimer is a product of _____

Answer 39

fibrin degradation

Question 40

non-invasive testing for DVT diagnosis

Answer 40

doppler ultrasonography

Question 41

invasive testing for DVT diagnosis

Answer 41

contrast venography

Question 42

lab findings in PE diagnosis

Answer 42

d-dimer elevation

Question 43

other ways to diagnose PE

Answer 43

ECG, chest xray, echo

Question 44

invasive testing for PE diagnosis

Answer 44

CT pulmonary angiography, ventilation/perfusion scan

Question 45

PE subtypes describe ____

Answer 45

the effect on the body, not the size of the clot

Question 46

massive PE

Answer 46

high risk, hemodynamic compromise, hypotension (SBP <90), may be candidates for thrombolytic therapy

Question 47

submassive PE

Answer 47

intermediate risk, without hemodynamic stability, evidence of right ventricular strain, positive cardiac biomarkers (troponin, BNP)

Question 48

non-massive PE

Answer 48

low risk

Question 49

for uncomplicated DVT and low-risk PE, what is preferred

Answer 49

outpatient, DOAC

Question 50

good DOAC candidates

Answer 50

clinically stable, CrCL>30 mL/min, no drug-drug interactions

Question 51

not good DOAC candidates

Answer 51

renal insufficiency, moderate to severe liver disease, significant drug interactions (CYP3A4 inducers)

Question 52

for limb-threatening DVT and intermediate to high risk PE, _____ is preferred

Answer 52

hospital admission and parenteral therapy

Question 53

advantages for DOACs in VTE

Answer 53

avoids parenteral therapy, predictable PK/PD effects, fixed dosing, similar or better efficacy with less major bleeding

Question 54

how to bridge to warfarin from parenteral anticoagulation

Answer 54

bridge until INR >2 on 2 consecutive readings 24 hours apart, minimum total overlap of 5 days

Question 55

how to bridge to DOAC from UFH

Answer 55

may discontinue infusion and give oral med simultaneously

Question 56

how to bridge to DOAC from LMWH or fondaparinux

Answer 56

give the oral dose when the next injection would have been due

Question 57

when is warfarin actually preferred

Answer 57

patients with renal insufficiency or antiphospholipid antibody syndromes

Question 58

why does warfarin have a delayed anticoagulation effect

Answer 58

it doesn't influence existing clotting factors, its onset is limited by decreased production of new clotting factors

Question 59

things to note when using warfarin for VTE

Answer 59

frequent monitoring is required, goal INR 2-3 for most, drug/food interactions influence dose

Question 60

VTE treatment duration

Answer 60

3-6 months unprovoked, indefinite for unprovoked

Question 61

apixaban dose for ongoing secondary prevention/risk reduction

Answer 61

2.5 mg bid

Question 62

rivaroxaban dose for secondary prevention/risk reduction

Answer 62

10 mg daily