18: Anticoagulant toxicity Flashcards
what is the INR target for mechanical heart valves, aFib and VTE
mech valves = 2.0-3.5
AFIB and BTE - 2.0-3.0
what is defined as minor bleeding
trivial bleed that resolves within 20 minutes
what is defined as a major bleed
bleeding into critical organ or a decline in HgB 20g/L (requires transfusions (1 pack of blood ~10g/L)
CBCs should be done _________ for those on anticoagulants
yearly
which is more easily treated? bleeds or clots
bleeds
what is the most feared bleeding complication
intracranial bleed
which 2 types of intracranial bleed is typically due to trauma in the elderly but prognosis is typically good
epidural or subdural hematoma
which of the following has worse prognosis
1. epidural hematoma
2. subdural hemoatoma
3. subarachnoid hemorrhage
4. intracerebral hemorrhage
5. 1+2
6. 3+4
6
why are intracranial hemorrhages so dangerous
Fixed space (within skull), concern with initial volume and expansion of bleeding
hemorrhages on anticoagulants have higher (3)
initial______
risk of _____
severity/ probability of ____
initial volume
risk of expansion
severity/ probability of death
DOACs reduce risk of aaICH by ________ compared to warfarin
30-70%
compared to warfarin, DOAC ICHs have (3)
______ volumes of blood
less severe ______/ more functional recovery
fewer ____s
smaller volumes of blood
less severe strokes/ more functional recovery
fewer deaths
what is the msot common extracranial bleed
GI
in extracranial major bleeding from ACs
1. majority result in full recovery spontaneously
2. requires reversal or interruption of treatment
3. the most common area is the lungs (pneumothorax)
4. none of the above is true
2
DOACs ___________ compared to warfarin
1. decreases both ICH and GI bleeds
2. increases ICH and decreases GI bleed
3. decreases ICH and increases GI bleed
4. increases ICH and GI bleeds
3 (but increase in GI bleeds is not stat sig)
T or F: high bleed risk score is not a reason to avoid anticoagulants
T
in ____, thrombotic and bleed rsk often rise in parallel
AF
what 6 things must you do for assessment of bleed
location
timing of blood loss
quantify and qualify blood loss
immediate mnagement
future management
impact of major bleed vs clotting event
generally, what is a good time to restart anticoagulation tx
____ usually
_ week if cause of bleed identified and rectified
_____ wks if conservative approach
2wks usually
1 week if cause of bleed identified and rectified
2-8 wks if conservative approach
observational data shows that restarting AC after GIB ____________________________
reduces risk of thrombosis and mortality and doesn’t increase risk of recurrence
observational data shows that restarting AC after ICH ___________________
decreases risk of ischemic events and mortality + no differences in major bleeding
critical INRs are defined as
INR >5.0
WHO requires labs to perform quality assurance testing between INR ________
1.5-4.5 only
what are 4 general categories of factors that elevate the INR
______ in health
changes to ________
changes to ______
administration of_________
deteriorations in health
changes to medications
changes to lifestyle
administration of too much warfarin
