Warfarin & anticoagulation Flashcards Preview

2 Cardiovascular > Warfarin & anticoagulation > Flashcards

Flashcards in Warfarin & anticoagulation Deck (23)
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1
Q

What is the purpose of anticoagulation and WHERE

A

Prevent thrombus in the slow moving venous circulation

DVT/PE

2
Q

What is the purpose of antiplatelets and WHERE

A

Prevent platelet aggregation and thrombus in the arterial circulation
(stroke)

3
Q

What is the difference between arterial and venous thrombi?

A

Venous - high fibrin, with platelets and RBC

Arterial - mainly platelets, low fibrin

4
Q

Mode of action of warfarin and duration to anticoagulant effect

A

vit k antagonism

48-72 hours

5
Q

How far from target INR is acceptable

A

0.5

6
Q

Target INR for AF/DVT etc

A

2.5

7
Q

Target INR for mechanical heart valves

A

depends on type of valve and pt factors

8
Q

When would you use target INR of 3.5

A

recurrent DVT/PE in pt already receiving anticoagulant with INR over 2

9
Q

Duration of anticoagulant treatment for

isolated calf DVT

A

6 weeks

10
Q

Duration of anticoagulant treatment for

VTE provoked by another factor - e.g. surgery

A

3 months

11
Q

Transient things that may provoke VTE (4)

A

surgery
COC
pregnancy
plastercast

12
Q

Duration of anticoagulant treatment for

unprovoked VTE

A

3 months at least

13
Q

Advice for major bleed on warfarin

A

stop warfarin
phytomenidione IV
give dried prothrombin complex or if no fresh frozen plasma

14
Q

Advice of INR over 8 and minor bleeding

A

stop warfarin
give phytomenidione IV
repeat if still too high after 24 hours

15
Q

After management of INR that is too high when should warfarin be reinitiated

A

INR

16
Q

Advice for INR over 8 and no bleeding

A

stop warfarin
give phytomenidione by mouth (unlicensed)
repeat if still too high after 24 hours

17
Q

advice for INR 5-8 and:

  • minor bleeding
  • no bleeding
A
-minor bleeding:
stop warfarin
give phytomenidione IV
-no bleeding
withhold 1-2 doses o f warfarin and reduce subsequent mantainance dose
18
Q

Adivce for bleeding at theraputic levels

A

investigate underlying cause e.g. renal or GI pathology

19
Q

How long before surgery should warfarin be stopped

when would we give phytomenidione day before before surgery

A

5 days

if the INR > 1.5 give phytomen day before

20
Q

when can we restart warfarin after surgery

A

evening of surgery or next day if all is well

21
Q

if someone is considered high risk for VTE before surgery how would we manage?
And who would be considered for this?

A

VTE in last 3 months, AF, previous TIA, heart valve

bridge with LMWH treatment dose, stop 24 hours before and start 28 hours after

22
Q

Is the risk of bleeding higher with asprin and warf or clop and warf

A

clop and warf

23
Q

what might be a day 1 dose of warfarin

A

5-10mg