Anticoag

Question 1

Warfarin: MOA

Answer 1

2, 7, 9, 10, Protein C and S

C and S have short half-lives, leaving 2/7/9/10 to be in abundance = hypercoagulable state

Bridge to avoid throwing a clot

Question 2

VTE: DOAC Dosing

Answer 2

Eliquis: 10 mg BID x7d then 5 mg BID

Xarelto: 15 mg BID x21d then 20 mg QD

Pradaxa: 150 mg BID (bridge edoxaban 5-10d)

Question 3

3 Steps for PE

Answer 3

1. Give 80 units/kg of heparin as bolus (max 10k)
2. 100 mg over 2 hours of alteplase
3. Give 18 units units/kg/hr of heparin as continuous infusion (max 2150)

Question 4

STEMI Tx

Answer 4

Heparin 60/12

MONA (morphine, oxygen, nitroglycerin, aspirin)

Question 5

Anti-Xa Range

Answer 5

0.3-0.7

Question 6

DOAC Antidotes

Answer 6

Eliquis/Xarelto: andexanet alfa

Pradaxa: idarucizumab

Question 7

DOAC Renal Considerations for VTE

Answer 7

Eliquis: N/A

Xarelto: CI CrCl < 15

Pradaxa: CI CrCl < 30

Question 8

Eliquis in A-fib

Answer 8

5 mg BID unless

2 of following:
Scr 1.5+
Age 80+
Wt (kg) 60+
= give 2.5 mg BID

Question 9

Warfarin Counseling

Answer 9

1. Anticoagulant aka blood thinner to help prevent harmful blood clots in the body
2. INR (what it is, importance)
3. AE (minor vs. major bleeding, fall/hit head, bruising)
4. Drug interactions (abxs, NSAIDs, amiodarone, SJW, coq10)
5. Food (consistency, leafy greens, green tea)
6. Don’t double up on doses or skip doses
7. Always tell providers you are on it
8. Same time every day (PM)

Question 10

Warfarin Reversal

Answer 10

1-10 mg of Vitamin K

Kcentra 35 if INR 4-6

FFP

Question 11

Surgery

Answer 11

-Stop warfarin 5 days before major surgery
-Stop LMWH 24 hours before major surgery
-Stop heparin 4 hours before major surgery