Anticoagulation

Question 1

What factors are contained in PCC 3 and 4 factor solution?

Answer 1

3 factor-II, IX, X
4 factor-II, VII, IX, X

Question 2

When giving Xarelto for the indication of Afib what are the doses depending on the creatinine clearance?

Answer 2

CrCl 50 or higher: 20mg QD
CrCl 15-50: 15mg QD
Avoid in those patients less than 15 CrCl, observe closely in those <30.

Question 3

What are the doses of Dabigatran depending on the CrCl for afib?

Answer 3

CrCl >30: 150mg BID
CrCl<30: 75mg BID
CrCl<15: no formal recommendation

Question 4

For what indication when using Eliquis do you dose reduce and what are the criteria for this?

Answer 4

You dose reduce only when using for Afib. If a patient has two of the following you dose reduce: age greater than 80, body weight less than 60kg, and creatinine >1.5. You dose reduce to 2.5mg BID.

Question 5

What is the reversal agent for Dabigatran for severe bleeding and what are some side effects?

Answer 5

Idarucizumab (praxbind). Side effects can include HA, hypokalemia, delirium, constipation, fever, and pneumonia.

Question 6

What is the reversal agent for direct Xa inhibitors for severe bleeding?

Answer 6

Andexanet Alfa

Question 7

When using activated charcoal what is the time frame you can use this for reversal of DOACs?

Answer 7

Within 2 hours.

Question 8

What is the Creatinine clearance cutoff for Lovenox?

Answer 8

Historically it’s has been less than 30, but UpToDate says you can give 1mg/kg once a day for less than 30.

Question 9

What are the conditions for which you should treat a superficial clot?

Answer 9

Those with extensive clots (greater than 5cm), less than 5cm from the deep venous system (saphenofemoral or saphenopopliteal junction), thrombosis present in large axial veins (great/small saphenous veins)

Question 10

For those that do require treatment of a superficial clot how do you treat them?

Answer 10

Prophylactic dose fondaparinux (highest amount of evidence exist for this), low dose DOAC, or LMWH for 6 WEEKS!

Question 11

In the presence of the following conditions should you also consider starting prophylactic AC for a superficial clot?

Answer 11

Prior DVT, thrombophilia, cancer, and estrogen therapy

Question 12

What is the mechanism of action for Vorapaxar?

Answer 12

It is a PAR-1 inhibitor or inhibitor of the thrombin receptor

Question 13

What is the mechanism of action of P2Y12 inhibitors?

Answer 13

By inhibiting the P2Y12 receptor they hence block ADP receptor binding.

Question 14

When giving Xarelto for treatment of DVT/PE or prophylaxis what is the renal cutoff to give this med?

Answer 14

You avoid in patients who have a CrCl less than 30.

Question 15

What are the doses of Xarelto for treatment of DVT/PE and prophylaxis for Hip or Knee Surgery?

Answer 15

DVT/PE: 15mg BID for 3 weeks followed by 20mg once daily
Knee/Hip: 10mg daily. Knee-12 days. Hip: 35 days

Question 16

What is the renal cutoff for Dabigatran when treating for DVT/PE?

Answer 16

Avoid use in patients with CrCl less than 30.

Question 16

What is the dose of Dabigatran when treating for DVT/PE or Stroke prophylaxis?

Answer 16

If CrCl greater than 30 you give 150mg BID for DVT/PE tx. For Afib-150mg BID, for CrCl of 15-30 it is 75mg BID.

Question 17

How is Warfarin Skin Necrosis Treated?

Answer 17

You want to stop warfarin right away and start heparin. You also want to give IV Vitamin K and FFP (to replenish Protein C)

Question 18

When should you suspect someone of having protein C def?

Answer 18

Recurrent VTE, VTE in an unusual site, warfarin skin necrosis, family history of VTE