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Anesthesia > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

MOA Heparin, enoxaparin

A

Interacts with antithrombin III to inhibit factors Xa and thrombin

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2
Q

Reversal heparin, enoxaparin

A

Protamine sulfate, Inactivates heparin via ionic compound formation

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3
Q

MOA Warfarin

A

Inhibits vitamin K activation, indirectly decreasing coagulation factor synthesis

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4
Q

Reversal warfarin

A

Vitamin K and prothrombin complex concentrate or FFP

Restores deficient vitamin K and vitamin K-dependent coagulation factors II, VII, IX, and X

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5
Q

MOA Dabigatran

A

Directly inhibits thrombin (factor IIa)

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6
Q

Reversal dabigatran

A

Idarucizumab, Binds and inhibits dabigatran at its active site

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7
Q

MOA Rivaroxaban, apixaban

A

Directly inhibit factor Xa

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8
Q

Reversal rivaroxaban, apixaban

A

Andexanet alfa, Binds apixaban or rivaroxaban as a decoy factor Xa molecule
**Andexanet alfa is not approved for the reversal of other factor Xa inhibitors (eg, edoxaban).

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9
Q

IV Heparin neuraxial guidelines

A

Hold before procedure: until PTT <40, usually 4-6 hours
Restart after procedure: 1 hour (if bloody tap, discuss!)
Hold before catheter removal: 4-6h from last dose and confirm PTT <40
Restart after catheter removal: 1 hour - with frequent neuro checks

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10
Q

Half life of heparin

A

1-2 hours

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11
Q

SC heparin 5000 U BID/TID neuraxial guidelines

A

Hold pre-proc: 4-6h or PTT <40
Restart post-proc: no delay
Hold pre cath removal: 4-6h
Restart post cath removal: no delay

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12
Q

SC heparin 7500-10000 U BID (<20,000 U per day) neuraxial guidelines

A

Hold pre-proc: 12h & PTT <40
Restart post-proc: avoid while catheter in place
Hold pre cath removal: avoid while catheter in place
Restart post cath removal: 12h & perform neuro checks

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13
Q

SC heparin >20k U daily neuraxial guidelines

A

Hold pre-proc: 24h & check PTT <40
Restart post-proc: assess individual case, monitor neuro checks
Hold pre cath removal: “ “
Restart post cath removal: “ “

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14
Q

Warfarin neuraxial guidelines

A

Hold pre-procedure: 5 days or INR =< 1.2, may be within 24 hours if single dose
Restart post-proc: no delay
Hold pre cath removal: INR <1.5 may remove; INR 1.5-3.0 maintain with caution and frequent neuro checks; INR >3.0 hold warfarin dose while catheter in place
Restart post cath removal: neuro checks x24h

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15
Q

Warfarin half life

A

20-60 hours

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16
Q

LMWH therapeutic dosing: enoxaparin, dalteparin, tinzaparin

A

Enox: 1 mg/kg SC BID or 1.5mg/kg QD
Dalt: 120u/kg BID or 200u/kg QD
Tinz: 175 u/kg QD

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17
Q

LMWH therapeutic dosing neuraxial guidelines

A

Hold pre-proc: 24h, consider checking anti-Xa in elderly/renal insufficiency
Restart post-proc: 24-72h (earlier if lower bleeding risk surgery, later if higher risk of bleeding) - if bloody tap, consider holding >24h
Hold pre cath removal: remove catheter before initiating LMWH
Restart post cath removal: minimum 4 hr, & at least 24h after initial cath placement

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18
Q

LMWH half life

A

4-7 hours

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19
Q

LMWH prophylactic dosing neuraxial guidelines

A

Hold pre-proc: minimum 12 hours
Restart post-proc: 12 hours
Hold pre cath removal: avoid
Restart post cath removal: 4 hr, at least 12h since initial placement (except in OB may restart 6-12h as long as catheter out for 4 hr and was not traumatic - if traumatic then 24h)

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20
Q

Fondaparinux neuraxial guidelines

A

Hold pre-proc: RAS has no recommendation; for pain hold 4 days
Restart post-proc: avoid
Hold pre cath removal: avoid with catheter
Restart post cath removal: 6 hours

*Consider holding longer in renal impairment; contraindicated in CrCl <30ml/min or Child-Pugh C hepatic failure

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21
Q

Fondaparinux half life

A

17-21 hours

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22
Q

Rivaroxaban neuraxial guidelines

A

Hold pre-proc: 72 hours
Restart post-proc: 6h, avoid with catheter
Hold pre cath removal: 22-26 hours
Restart post cath removal: 6 hours unless traumatic - then discuss

*Consider holding longer in renal impairment; contraindicated in CrCl <15ml/min or Child-Pugh C hepatic failure

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23
Q

Rivaroxaban half life

A

5-9 hours

24
Q

Apixaban neuraxial guidelines

A

Hold pre-proc: 72 hours
Restart post-proc: 6 hr, avoid if catheter
Hold pre cath removal: 26-30 hours
Restart post cath removal: 6 hr unless traumatic - then discuss

*Consider holding longer in renal impairment; contraindicated in CrCl <15ml/min or Child-Pugh B or C hepatic failure

25
Q

Apixaban half life

A

6-12 hours

26
Q

Edoxaban neuraxial guidelines

A

Hold pre-proc: 72 hours
Restart post-proc: 6 hr, avoid with catheter
Hold pre cath removal: 20-28 hours
Restart post cath removal: 6 hr unless traumatic - then discuss

*Consider holding longer in renal impairment; contraindicated in CrCl <30ml/min or Child-Pugh B or C hepatic failure

27
Q

Edoxaban half life

A

10-14 hours

28
Q

Argatroban neuraxial guidelines

A

Hold pre-proc: avoid
Restart post-proc: avoid with catheter
Hold before cath removal: 34-36hr
Restart post cath removal: 2 hr

29
Q

Argatroban half life

A

40-50 minutes

In hepatic impairment: 181 minutes

30
Q

Bivalirudin neuraxial guidelines

A

Hold pre-proc: avoid
Restart post-proc: avoid with catheter
Hold pre cath removal: 34-36h
Restart post cath removal: 2 hr

31
Q

Bivalirudin half life

A

25 min

With CrCl 10-29: 57 min

32
Q

Dabigatran neuraxial guidelines

A

Hold pre-proc: 5-6 days generally. 3 days if CrCl >80, 4 days if 50-79, 5 days if 30-49, avoid neuraxial if <30.
Restart post-proc: 6 hr, avoid with catheter
Hold pre cath removal: 34-36hr
Restart post cath removal: 6 hr or 24 if traumatic

33
Q

Dabigatran half life

A

8-17 hours

34
Q

Aspirin neuraxial guidelines

A

No restrictions

35
Q

Clopidogrel neuraxial guidelines

A

Hold pre-proc: 5-7 days
Restart post-proc: immediately if no loading dose; 6 hours for loading dose
Hold pre cath removal: 24hr
Restart post cath removal: immediately, or 6 hr for loading dose

36
Q

Clopidogrel half life

A

6 hours

*Metabolites longer (entire platelet lifespan)

37
Q

Cilostazol neuraxial guidelines

A

Hold pre-proc: 48 hours (or longer if renal impairment)
Restart post-proc: 6 hr; avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: 6 hours

38
Q

Cilostazol half life

A

11-13 hours

39
Q

Dipyridamole neuraxial guidelines

A

Hold pre-proc: 24hr
Restart post-proc: 6 hours; avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: 6 hours

40
Q

Dipyridamole half life

A

10-12 hours

41
Q

Prasugrel neuraxial guidelines

A

Hold pre-proc: 7-10 days
Restart post-proc: immediately if no loading dose, then 6h; avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: 24h post-op; immediately or 6h for loading dose

42
Q

Prasugrel half life

A

2-15 hours

43
Q

Ticagrelor neuraxial guidelines

A

Hold pre-proc: 5-7 days
Restart post-proc: immediately, or 6h for loading dose; avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: 24h post-op; immediately or 6h for loading dose

44
Q

Ticagrelor half life

A

7 hr

9 hr for metabolite

45
Q

Ticlodipine neuraxial guidelines

A

Hold pre-proc: 10d
Restart post-proc: immediately, or 6h for loading dose; avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: 24h post op; immediately or 6h for loading dose

46
Q

Ticlodipine half life

A

13 hours

47
Q

Cangrelor neuraxial guidelines

A

Hold pre-proc: 3 hours
Restart post-proc: 8 hours, avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: 8 hours

48
Q

Cangrelor half life

A

3-6 minutes

49
Q

Fibrinolytics neuraxial guidelines (streptokinase, alteplase, tenecteplase, reteplase)

A

Hold pre-proc: 10 days, or 48 hours with normal clotting studies (including fibrinogen)
Restart post-proc: avoid with catheter
Hold pre cath removal: avoid with catheter; q2h neuro checks if unanticipated event & change infusion so able to monitor
Restart post cath removal: check fibrinogen level

50
Q

Streptokinase half life

A

18-83 minutes

51
Q

Alteplase half life

A

26-46 hours

52
Q

Tenecteplase half life

A

115 minutes

53
Q

Reteplase half life

A

13-16 minutes

54
Q

GP IIb/IIIa inhibitor neuraxial guidelines

A

Hold pre-proc: 24-48 hr (abciximab) or 4-8 hr (eptifibatide & tirofiban)
Restart post-proc: avoid with catheter
Hold pre cath removal: avoid with catheter
Restart post cath removal: contraindicated 4w post-op

55
Q

Half life abciximab

A

30 min

56
Q

Half life eptifibatide

A

2.5 hours

57
Q

Half life tirofiban

A

2 hours

Anesthesia (9 decks)

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