Anticoagulants

Question 1

Heparin is administered by:

Answer 1

Continuous infusion

- To large for oral absorption

Question 2

UFH typical prophylaxis dose:

Answer 2

5,000 units q8-12hrs SQ

- SQ so that you don’t have to put a line in.

Question 3

When do we give UFH bolus doses?

Answer 3

When immediate and full anticoagulation is required.
- NEVER if stroke

Follow up with continuous infusion.

Question 4

What do we use to monitor UFH

Answer 4

aPTT most places
Range: 76-120

Antifactor Xa some places
Range: 0.3-0.7 UmmL

Question 5

UFH typical continuous infusion dose:

Answer 5

15-18 U/kg IV

Question 6

UFH typical bolus dose:

Answer 6

80-100 U/kg IV

Question 7

When do we usually check aPTT levels with UFH?

Answer 7

6 hours

Question 8

Check anti-Xa levels with UFH if:

Answer 8

aPTT falsely elevated due to:

Antiphospholipid Antibiodies (APLA)
Advanced liver disease
SLE

Question 9

When to check chromogenic factor Xa with Warfarin

Answer 9

INR falsely elevated due to:

Anticardiolipins
Advanced liver disease
SLE

Question 10

Reasons for newer anticoagulant drugs:

Answer 10

Oral formulation

HIT

Question 11

LMWH typical treatment dose

Answer 11

1 mg/kg q12

Question 12

Enoxaparin in CrCl < 30mL/min

Answer 12

Reduce dose to 1mg/kg/DAY

Check levels 4 hours after the 2nd and 3rd doses.

Question 13

When to check Anti-Xa levels with LMWHs:

Answer 13

CKD
Pregnancy
Obesity

Question 14

Fondaparinux

Answer 14

Pretty much only use if they got HIT.
Very long t1/2
DC if CrCl < 30

Question 15

Time to full anticoagulation with Warfarin

Answer 15

5-15 days

Question 16

Argatroban

Answer 16

For patients with intermediate to high risk of HIT.
Goal aPTT: 40-70
Draw aPTT after 2hrs

Question 17

DOAC Targets

Answer 17

Dabigatran: IIa
Rivaroxaban: Xa
Apixaban: Xa

Question 18

DOAC t1/2

Answer 18

Dabigatran >
Rivaroxaban >
Apixaban

Question 19

Therapeutic Anti-Xa levels for enoxaparin

Answer 19

0.7-1.2

Question 20

Warfarin starting dose

Answer 20

2.5<5mg initially

NOT 10mg like CHEST says

Question 21

Heparin to warfarin

Answer 21

After 2 stable INRs

Question 22

Monitoring warfarin in patients with APLA and lupus

Answer 22

Chromogenic Factor Xa

• Goal level: 40-20%
• The lower the number, the more anticoagulated they are
• Need to do this every few months to ensure INR correlates correctly.

Question 23

MUST CALCULATE CrCl ON TEST!

Answer 23

NEEDED FOR ENOXAPARIN DOSING

Question 24

DOAC of choice for patients with renal dysfunction

Answer 24

Apixaban

- Dual metabolism.

Question 25

Which anticoagulant do you use for Prosthetic Mitral Valve patients? INR goal? Duration of treatment?

Answer 25

Warfarin.
INR goal: 2.5-3.5
Duration: indefinite.

Question 26

Warfarin monitoring

Answer 26

INR check daily initially things are stable and they are out of your hands.

Question 27

LMWH medicine prophylaxis dose

Answer 27

40mg QD

Question 28

LMWH hemodialysis prophylaxis dose

Answer 28

20mg QD

Question 29

LMWH trauma prophylaxis dose

Answer 29

30mg q12**