Anticoagulants Flashcards
which anticoagulants carry a risk of epidural haematoma (collection of blood in between skull and dura mater)
- NOACs and DOACs
e.g (rivaroxaban, dabigatran
apixaban, edoxaban)
note: no evidence of risk with lmwh eg dalteparin
name the 2 types of juice that interact with warfarin
Cranberry + pomegranate juice
both increase INR so increase warfarins anticoagulant effect
which anticoagulants can be used in pregnancy (e.g for DVT/VTE)
LMWH (low molecular weight heparins):
Dalteparin
Enoxaparin
Tinzaparin
how long is rivaroxaban given for to prevent VTE after a KNEE replacement surgery
2 weeks
how long is rivaroxaban given for to prevent VTE after a HIP replacement surgery
5 weeks
what do you do if: INR 5.0–8.0, no bleeding
withhold 1 or 2 doses of warfarin sodium and reduce subsequent maintenance dose
what do you do if: INR 5.0–8.0, minor bleeding
stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; restart warfarin sodium when INR <5.0
what do you do if: INR >8.0, no bleeding
stop warfarin sodium; give phytomenadione (vitamin K1) by mouth using the intravenous preparation orally [unlicensed use]; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0
what do you do if: INR >8.0, minor bleeding
stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0
what do you do if: a patient taking warfarin has a major bleed
stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; give dried prothrombin complex (factors II, VII, IX, and X); if dried prothrombin complex unavailable, fresh frozen plasma can be given but is less effective
note: recombinant factor VIIa is not recommended for emergency anticoagulation reversal
what should a patients INR ideally be if they are switch from warfarin to a DOAC straight away
<2
which PPIs decrease the efficacy of clopidogrel
omeprazole + esomeprazole
why should patients on warfarin report if they get a painful skin rash
warfarin use may lead to calciphylaxis ( calcium accumulates in small blood vessels of the fat and skin tissues)
what colour is the warfarin 1mg tablet
brown
what colour is the warfarin 3mg tablet
blue
what colour is the warfarin 5mg tablet
pink
how long should a patient take warfarin for isolated calf-vein deep-vein thrombosis
6 weeks
how long should a patient take warfarin for VTE provoked by surgery or other transient factors
3 months
how long should a patient take warfarin for unprovoked proximal DVT or PE
at least 3 months
how long should a patient take warfarin for AF (atrial fibrillation)
lifelong
how long should a patient take warfarin for prosthetic heart valve
lifelong
what are the contraindications for NOACs (apixaban, dabigatran + rivaroxaban)
- a lesion or condition that is a risk of major bleeding
- concomitant treatment with any other anticoagulant agent
which anticoagulant should not be used for thromboprophylaxis in patients with prosthetic heart valves, including patients who have undergone TAVR (transcatheter aortic valve replacement)
rivaroxaban (MHRA warning)
which anticoagulants are not recommended in patients with antiphospholipid syndrome
DOACS
note: particularly high-risk patients who test positive for all three antiphospholipid tests—lupus anticoagulant, anticardiolipin antibodies, and anti-beta2 glycoprotein I antibodies. consider switching to warfarin
describe how rivaroxaban 15mg + 20mg tablets should be taken (counselling points)
- take with food
- on those who have difficulty swallowing, these tablets can be crushed and mixed with water or apple puree immediately before, and followed by food immediately after, ingestion
which anticoagulants are contraindicated in patients with a heart valve
DOACs
