Warfarin & anticoagulation Flashcards Preview

2 Cardiovascular > Warfarin & anticoagulation > Flashcards

Flashcards in Warfarin & anticoagulation Deck (23):
1

What is the purpose of anticoagulation and WHERE

Prevent thrombus in the slow moving venous circulation
(DVT/PE)

2

What is the purpose of antiplatelets and WHERE

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

3

What is the difference between arterial and venous thrombi?

Venous - high fibrin, with platelets and RBC
Arterial - mainly platelets, low fibrin

4

Mode of action of warfarin and duration to anticoagulant effect

vit k antagonism
48-72 hours

5

How far from target INR is acceptable

0.5

6

Target INR for AF/DVT etc

2.5

7

Target INR for mechanical heart valves

depends on type of valve and pt factors

8

When would you use target INR of 3.5

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

9

Duration of anticoagulant treatment for
isolated calf DVT

6 weeks

10

Duration of anticoagulant treatment for
VTE provoked by another factor - e.g. surgery

3 months

11

Transient things that may provoke VTE (4)

surgery
COC
pregnancy
plastercast

12

Duration of anticoagulant treatment for
unprovoked VTE

3 months at least

13

Advice for major bleed on warfarin

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

14

Advice of INR over 8 and minor bleeding

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

15

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

INR

16

Advice for INR over 8 and no bleeding

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

17

advice for INR 5-8 and:
-minor bleeding
-no bleeding

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

18

Adivce for bleeding at theraputic levels

investigate underlying cause e.g. renal or GI pathology

19

How long before surgery should warfarin be stopped
when would we give phytomenidione day before before surgery

5 days
if the INR > 1.5 give phytomen day before

20

when can we restart warfarin after surgery

evening of surgery or next day if all is well

21

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

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

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

clop and warf

23

what might be a day 1 dose of warfarin

5-10mg