Anticoagulation Flashcards
What conditions require anticoag
AF
Metallic heart valves
Nephrotic syndrome
Stroke prophylaxis
Why need to rescribe LMWH with warfarin
Initially -> prothrobotic state
LMWH until INR in range
Can cause skin necroesis/repeat VTE if not
Which rug is best used to anticoagulate in extremes of body weight
Warfarin ir LMWH
What anticoag for poor renal fucntion
Warfarin
What DOAC interact with drug wise
Antiepileptics
What drug to use if goal INR is >3
Warfarin + LMWH - only way can increase intensity
How long before surgery stop wargarin
- High risk of VTE
- AF w CHAD>4, recent CVA/TIA
- Metallic mitral valve - not aortic unless other risk factors
When do you bridge warfarin before a surgery rather than stopping
- High risk of VTE
- AF w CHAD>4, recent CVA/TIA
- Metallic mitral valve - not aortic unless other risk factors
- Last dose 24 hours pre surgery - 50% before high risk if once daily dosing
- Restart 28 hours post surgery
How do different DOACs affect lab tests
Dabigatran
- V prolonged PT, tends to prolong APTT
Rivaroxaban
- Prolong PT
Apixaban - often doenst affect blood sreen at all
What do with DOACs before procedure
Low risk + normal renal function - stop 24 hours before
High risk and normal renal function
- Stop 48 hours before procedure
- Dont reintroduce until 48 hours after
- High thrombotic risk - thromboprophylais prior to reintroduction of DOAC
How reverse warfarin
IV Vit K 5mg - 4-6 hours Beriplex 30U/kg - 15 mins (give with vit K)
What use for unfract. heparin reversal
Stop infusion
Protamine
What can protamine cause
reactions bradycardia and drop in BP
Reversal of dabigatran
last 2 hours taken - activated charcoal
2 doses praxabind 2.5g 15 mins apart (idarucizumab)
Dialysis if not available
How to reverse anti-Xa inhbitors
Activated cahrcoal if within 2 hours
No speciic antidote
