AC: Special Populations

Question 1

Dalteparin: Renal

Answer 1

CrCl < 30: avoid

Question 2

Enoxaparin: Renal

Answer 2

CrCl 20-30: 1 mg/kg

CrCl < 20: UFH preferred, can do 0.7 mg/kg + measure trough levels

Question 3

Bivalirudin: Renal

Answer 3

CrCl 30-60: 0.08 mg/kg/hr

CrCl 10-29: 0.05

IHD: 0.04

Question 4

Fondaparinux: Renal

Answer 4

CrCl < 30: avoid in vte

Question 5

LMWH: Renal

Answer 5

Avoid all LMWH in ESRD and hemodialysis

Question 6

Obesity (BMI > 40)

Answer 6

UFH SC (prophylaxis)
-7500 TID
-10k BID
*if wt >120kg

LMWH SC
-0.75 mg/kg BID

Fonda
-10 mg for wt >100kg

Question 7

Obesity + DOACs

Answer 7

-Apixaban
-Rivaroxaban
-Warfarin

Question 8

AC in Pregnancy

Answer 8

1. LMWH preferred
2. UFH second line if patient has renal insufficiency

Question 9

AC in Cancer

Answer 9

1. LMWH for initial tx (> 30 CrCl)
2. Apixaban or Rivaroxaban or Edoxaban (after 5d) for initial tx
3. Can use UFH if above are CI

LMWH + DOACs min of 6 mo

Question 10

Secondary Event in Thrombophilias and VTE

Answer 10

Minimum period of treatment at least 3-6 months for
patients with inherited thrombophilia

Long-term if protein C/S or AT3 or antiphospholipid deficiencies

2+ events: indefinite tx

Question 11

Lupus Anticoagulant and Interference with Monitoring Parameters

Answer 11

Heparin: aPTT is not reliable
= USE ANTI XA

Warfarin:
= USE CHROMOGENIC ASSAY FOR FACTOR X

Question 12

Timing of AC Interruption for Surgery

Answer 12

Warfarin: DC 5 days prior + bridging

UFH: DC 4 hours prior

LMWH: DC 24 hours prior

Question 13

Extended Prophylaxis after Hospital Discharge

Answer 13

Betrixaban 160 mg x1 then 80 mg x42d

Riva 10 mg x31-39d