Anticoagulants Flashcards
Wafarin INR > 8
Minor bleeding: IV
No bleeding: PO 2.5mg
Wafarin INR 5-8
Bleeding: IV
No bleeding: withold 1-2 doses
Warfarin: SE
- Painful rash
- Haemorrhage, prolonged bleeding
Warfarin: administration
OD evening
empty
Abx which decrease anticoagulant effect of warfarin
Rifampicin
Abx which increase anticoagulant effect of warfarin
C
D
E
M
Switching warfarin to dabigatran
o Yes in diabetes
o No in GI ulcer, prosthetic heart valve, recent surgery, malignant neoplasm
Which DOACs have reversible agents?
DAR
When is apixaban 2.5mg bd indicated?
Creatinine clearance is 15-29mL/min
or the following TWO apply from:
1) 80 +
2) 60kg or less
3) serum creatinine 133 micromol/L or over.
Apixaban: renal
CI < 15
Edoxoban: SPAF
< 60kg = 30mg OD
> 60kg = 60mg OD
How long before surgery should you discontinue edoxaban?
24h
Edoxaban: renal
Avoid < 15
Edoxaban and ketonazole max dose
30mg OD
Rivaroxaban: ACS
2.5mg BD
What is the dose for rivaroxaban in patients with DVT/PE?
15mg BD (twice daily) for 21 DAYS then 20mg OD (once daily)
Rivaroxaban: administration
Swallow whole (can crush)
15 + 20mg must be with food otherwise absorption is decreased
Rivaroxaban: renal
Avoid < 15
Dabigatran: administration
Cannot be crushed
Whereas other DOACs and VKA can
Dabigatran + amiodarone and verapamil
Decrease the dose
Administer the drugs at the same time
What autoimmune disease should DOACs be avoided in
Antiphospholipid syndrome
Use VKA instead
Dabigatran: renal
Avoid < 30
Which DOAC is least likely to be chosen with renal impairment?
Dabigatran
How many days prior to elective surgery should ticagrelor be stopped?
5
How many days should you STOP clopidogrel prior to elective surgery?
7
