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Therapeutics II > Anti-Coagulation In Lecture > Flashcards

Anti-Coagulation In Lecture Flashcards

1
Q

Virchow’s Triad

A
  • abnormalities of clotting components (hypercoagulable state)
  • abnormality of surfaces in contact with blood flow (endothelial injury)
  • abnormalities in blood flow (circulatory stasis)
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2
Q

DOACs for post operative prophylaxis

A
  • dabigatran
  • rivaroxaban
  • apixaban
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3
Q

Dabigatran dosing changes (post-op prop doses)

A
  • day of surgery = 110 mg QD
  • not day of surgery = 220 mg QD
  • maintenance dose = 220 mg QD
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4
Q

Dabigatran is for ____ only

A

HIP ONLY

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5
Q

Rivaroxaban dosing (post-op prop doses)

A

10 mg QD x35 days

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6
Q

Apixaban dosing (post-op prop doses)

A

2.5 mg BID x 35 days

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7
Q

Rivaroxaban (post-op prop doses) avoid use when

A

CrCl is < 30 ml/min

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8
Q

DOACs for non-valvular atrial fibrillation

A
  • dabigatran
  • rivaroxaban
  • apixaban
  • edoxaban
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9
Q

Dabigatran (non-valvular atrial fibrillation dosing)

A

150 mg BID

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10
Q

Rivaroxaban (non-valvular atrial fibrillation dosing)

A

20 mg QD

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11
Q

Apixaban (non-valvular atrial fibrillation dosing)

A

5 mg BID

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12
Q

Edoxaban (non-valvular atrial fibrillation dosing)

A

60 mg PO QD

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13
Q

Remember that all DOACs are

A

adjusted for renal flow

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14
Q

How to renally adjust DOACs for non-valvular atrial fibrillation dosing

A
  • dabigatran, rivaroxaban, edoxaban are adjusted based on CrCl
  • Apixaban dosing based on SCr
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15
Q

Edoxaban should not be used for non valvular atrial fibrillation when

A

CrCl is > 95 ml/min

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16
Q

Apixaban dosing for non-valvular atrial fibrillation is based on (3 things)

A
  • age (>/= 80)
  • SCr (< 1.5 mg/dl)
  • Weight (= 60 kg)
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17
Q

DOACs for DVT/PE treatment

A
  • dabigatran
  • rivaroxaban
  • apixaban
  • edoxaban
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18
Q

Dabigatran DVT/PE treatment dosing

A

150 mg BID

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19
Q

Rivaroxaban DVT/PE treatment dosing

A

15 mg BID x 3 weeks, then 20 mg QD

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20
Q

Apixaban DVT/PE treatment dosing

A

10 mg BID x7 days, followed by 5 mg BID

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21
Q

Edoxaban DVT/PE treatment dosing

A

60 mg QD

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22
Q

Apixaban renal adjustment dosing based on

A

SCr (> 2.5 mg/dL)

23
Q

DOACs for DVT/PE tx: dabigatran and edoxaban…

A

require 5 - 10 days parental anticoagulation

24
Q

Edoxaban (DVT/PE treatment) is wt is

A

= 60 kg = dose is 30 mg QD

25
Q

For DVT/PE tx, which DOACs don’t require parental anticoagulation

A

rivaroxaban and apixaban

26
Q

DOACs for secondary treatment of recurrent DVT/PE

A

rivaroxaban and apixaban

27
Q

Rivaroxaban dosing for secondary treatment of recurrent DVT/PE

A

20 mg PO QD

28
Q

Apixaban dosing for secondary treatment of recurrent DVT/PE

A

2.5 mg PO BID

29
Q

For both rivaroxaban and apixaban for secondary treatment of recurrent DVT/PE…

A

this is considered after an initial 6 months of treatment (these drugs can be used during months 6 - 12)

30
Q

DOACs that can be used for VTE prophylaxis (for acutely ill patients)

A

rivaroxaban and BETRIXABAN (ONLY PLACE THIS SHOWS UP)

31
Q

Rivaroxaban VTE prophylaxis dosing

A

10 mg PO QD (31 - 39 days)

32
Q

Betrixaban VTE prophylaxis dosing

A

160 mg PO QD (Day 1); 80 mg PO QD (35 - 42 days)

33
Q

Warfarin Initial Dose (same dose if unsure)

A

5 mg PO QD

34
Q

Warfarin Initial Dose for Healthy Outpatients

A

10 mg PO QD

35
Q

Warfarin should be overlapped with

A

UFH or LMWH for at least 5 days and until INR is therapeutic

36
Q

Must adjust the ______ dose to achieve therapeutic INR

A

weekly dose

37
Q

The one exception when a pt may be started on just warfarin

A

when the pt has atrial fibrillation

38
Q

Goal INR of 2.0 - 3.0 recommended for pts with

A
  • prophylaxis of VTE
  • tx of VTE or PE
  • Prevention of systemic embolism (tissue heart valves, AMI, valvular heart disease, atrial fibrillation)
  • antiphospholipid antibody syndrome
  • mechanical heart value (aortic)
39
Q

INR goal of 1.5 - 2.0 when

A

the pt has an aortic valve replacement - mechanical On-X

40
Q

INR goal of 2.5 - 3.5 when

A

the pt has a mechanical heart valve (mitral, caged ball, high risk)

41
Q

AMI is an oral anticoagulant that prevents

A

recurrent MI, INR of 2.5 - 3.5 is recommended

42
Q

Warfarin Maintenance therapy: If dose held today

A

check within 1 - 2 days

43
Q

Warfarin Maintenance therapy: If dose change today

A

check within 1 - 2 weeks

44
Q

Warfarin Maintenance therapy: If dosage change = 2 weeks ago

A

check within 2 - 4 weeks

45
Q

Warfarin Maintenance therapy: Routine follow-up for stable pt

A

check every 4 - 6 weeks

46
Q

Warfarin Maintenance therapy: Routine follow-up for unstable pt

A

check every 1 - 2 weeks

47
Q

Warfarin Maintenance therapy: Consistently stable (i.e. no change in 6 months

A

check every 12 weeks

48
Q

Patient Interview: Warfarin Questions

A
  • 5 Ds:
  • Drugs (interactions)
  • Diseases (changes in overall medical condition)
  • Doses (any missed doses)
  • Diet (any changes, specifically leafy green vegetables)
  • Drink (any alcohol consumption)

*Bruising/bleeding

49
Q

When to have a warfarin dose adjustment

A
  • s/sx of bleeding
  • thromboembolic complications
  • prescription medication changes
  • diet
  • activity
  • etoh use
  • AE
  • OTC drug use
  • drug interaction screening
50
Q

Warfarin Protocol: Goal = 2.0 - 3.0

A
  • INR < 2 = Increase 5 - 15%
  • INR 3.1 - 3.5 = Decrease by 5 - 15%
  • INR 3.5 - 4.0 = Hold 0 - 1 dose, decrease by 10 - 15%
  • INR > 4.0 = Hold 0 - 2 doses, decrease by 10 - 15%
51
Q

Warfarin Protocol: Goal = 2.5 - 3.5

A
  • INR < 2.5 = Increase 5 - 15%
  • INR 3.6 - 4.0 = Decrease by 5 - 15%
  • INR 4.1 - 4.5 = Hold 0 - 1 dose, decrease by 10 - 15%
  • INR > 4.5 = Hold 0 - 2 doses, decrease by 10 - 15%
52
Q

Bridging warfarin not required for

A

new anticoagulants and typically not for dental, dermatologic, or cataract procedures

53
Q

In warfarin bridging is needed (i.e. during an invasive procedure)

A

-stop warfarin 5 days before surgery

  • give LMWH or UFH until the procedure
  • **stop LMWH 24 hrs before procedure
  • **stop IV UFH 4 - 6 hrs before procedure

-resume warfarin 12 - 24 hours after surgery (assuming adequate hemostasis)

54
Q

The LMWH usually used to bridge warfarin is

A

enoxaparin

Therapeutics II (12 decks)

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