Anticoag Special Population √ Flashcards
Dalteparin Kidney consideration
Crcl <30 DO NOT USE
Crcl equation
Enoxaparin with Crcl 20-30
1mg/kg qd
Enoxaparin with Crcl < 20 or dialysis
0.7 mg/kg daily but better to swtich
Bivalirudin CrCL 30-60, 10-29 or CVVHD, IHD DO NOT NEED TO KNOW FOR TEST YES FOR ROTATIONS
.08 mg/kg/hr
Bivalirudin CrCL 10-29 DO NOT NEED TO KNOW FOR TEST YES FOR ROTATIONS
.05 mg/kg/h
Bivalirudin CVVHD or IHD DO NOT NEED TO KNOW FOR TEST YES FOR ROTATIONS
.04 mg/kg/hr
Fondaparinux CrCL <30
AVOID
Cut off for Dabigatran Crcl
< 30 do not use
Cut off for rivaroxaban Crcl
< 15 do not use
Edoxaban cut off for Crcl
< 15 do not use
Dose consideration for Crcl 15-50, ≤60 or on PgP for Edoxaban
30 mg QD
Enoxaparin prophylaxis dosing for VTE
30 mg SQ BID or
40 mg SQ QD
Anti-Xa levels for high risk populations for LWMH
what renal conditions should i avoid LWMH
ESRD and Hemodyalysis
What anticoagulant should be given to a patient with a high BMI
apixaban or rivaroxaban
What anticoagulant can we use in pregnancy
LMWH and UFH
Will usually use Endoxaparin
What drugs can we use for Cancer patietns
LWMH is number one if cant use (Crcl < 30)
can use DOAC
If a Cancer patient is contraindicated for LWMH and DOAC (like a patient on dialysis) what do we use
unfractionated heparin
What testing do i chose to monitor levels with a pt with anti phospholipid symdome
Use anti Xa
When do we think thrombophilias may be present
Family history
VTE before 40
A lot of miscarries for pregnant people
For thrombophilias Carrier what 2 situation can we adjust med and what is the guideline
Pregnancy with fetal loss
Antepartum - AT3 deficiency use UFH or LMWH
Post partum - AT3, Protein C or Protein S - give prophylaxis of SQ UFH or LMWH or warfarin for 6 months
What is the prophylaxis dose of heparin
5,000 units SC BID-TID
When are you using anticoagulant for life
2 or more spontaneous episodes of VTE
when do i stop anticoagulants for surgeries
when do i stop anticoagulants for surgeries just DOAC
