Anticoagulation

Question 1

Which drugs require 5-10 days of parental anticoagulation beforehand (for DVT/PE treatment)?

Answer 1

Dabigatran
Edoxaban

Question 2

Reversal agent for dabigatran:

Answer 2

Idarucizumab (Praxbind)

Question 3

Reversal agent for Factor Xa inhibitors (apixaban and rivaroxaban):

Answer 3

Andexanet alfa

Question 4

Reversal agent for heparin + LMWH:

Answer 4

Protamine sulfate

Question 5

Warfarin rapid reversal agent:

Answer 5

Prothrombin complex concentrate

Question 6

Warfarin bleeding management: major bleeding

Answer 6

Prothrombin complex concentrate preferred over fresh frozen plasma

Question 7

Warfarin bleeding management: INR 4.5 - 10 and no evidence of bleeding

Answer 7

avoid vitamin K

Question 8

Warfarin bleeding management: INR > 10 and no evidence of bleeding

Answer 8

PO vitamin K

Question 9

INR goal: 2-3
current: <2.0

Answer 9

increase dose by 5-15%

Question 10

INR goal: 2-3
current: 3.1-3.5

Answer 10

decrease dose by 5-15%

Question 11

INR goal: 2-3
current: 3.5-4

Answer 11

hold 0-1 doses
and/or
decrease 10-15%

Question 12

INR goal: 2-3
current >4.0

Answer 12

hold 0-2 dose
and/or
decrease 10-15%

Question 13

INR goal: 2.5-3.5
current: <2.5

Answer 13

increase by 5-15%

Question 14

INR goal: 2.5-3.5
current: 3.6-4.0

Answer 14

decrease by 5-15%

Question 15

INR goal: 2.5-3.5
current: 4.1-4.5

Answer 15

hold 0-1 doses
and/or
decrease by 10-15%

Question 16

INR goal: 2.5-3.5
current: > 4.5

Answer 16

hold 0-2 doses
and/or
decrease by 10-15%

Question 17

Drugs that may increase INR

Answer 17

Bactrim
metronidazole
fluconazole
ciprofloxacin
amiodarone
+
acute EtOH ingestion

Question 18

CHA2DS2-VASC score:

Answer 18

congestive heart failure - 1
HTN - 1
age > 75 - 2
diabetes - 1
stroke/TIA - 1
Vascular disease - 1
age 65-74 years - 1
female -

Question 19

Above what CHADS-VASc score is oral anticoagulation recommended?

Answer 19

equal to or > 2