Anticoagulants

Question 1

What are some indications for bridging in patients on warfarin?

Answer 1

Mechanical Mitral or aortic valve with additional stroke risk factors
Embolic stroke within the previous 3 months
Very high CHADS2(5 or 6)
VTE within the previous 3 months
Recent coronary stenting in selected patients
Previous VTE during interruption of chronic anticoagulation

Question 2

When is the right time to screen for thrombophilia is a 30 year old patient with new DVT and family history of early onset VTE?

Answer 2

2 to 4 weeks after completing anticoagulation because AT III, Protein C and S are altered by acute thrombosis and warfarin, heparin disrupts lupus anticoagulant panel

Question 3

Who should be screened for thrombophilia?

Answer 3

Patients with thrombosis in unusual sites
Recurrent idiopathic thrombosis
Patients with warfarin induced skin necrosis
Patients with VTE and a clear family history of thrombosis in more than one 1st degree relative

Question 4

What antibodies or genetic mutations are checked in thrombophilia screening

Answer 4

Factor V leiden
Lupus anticogulant/anti phospholipid antibody
Protein C and S
Anti thrombin deficiency 
Prothrombin gene mutation

Question 5

What is the indication for IVC filter in a patient with VTE?

Answer 5

Proximal or pelvic DVT in a patient who cannot undergo anticoagulation due to very high bleeding risk or active bleeding