Anticoagulation Flashcards
Memorize, understand, apply
What are the indications for unfractionated heparin?
VTE Prophylaxis
VTE Treatment
ACS/STEMI Treatment
What are the indications for enoxaparin?
VTE Prophylaxis
VTE Treatment
UA/NSTEMI Treatment
STEMI Treatment
What are the indications for dalteparin?
VTE Prophylaxis
UA/NSTEMI Treatment
What are the indications for apixaban?
Nonvalvular AF (Stroke Prophylaxis)
DVT/PE Treatment
DVT Prophylaxis (Hip/Knee Surgery)
What are the indications for rivaroxaban?
Nonvalvular AF (Stroke Prophylaxis)
DVT/PE Treatment
DVT Prophylaxis (Hip/Knee Surgery)
VTE Treatment (Acutely Ill Medical Patients)
Reduction of Major CVD Events (PAD/CAD)
What are the indications for edoxaban?
Nonvalvular AF (Stroke Prophylaxis)
DVT/PE Treatment
What are the indications for dabigatran?
Nonvalvular AF (Stroke Prophylaxis)
DVT/PE Treatment
Decrease recurrence of DVT/PE
DVT Prophylaxis (Hip surgery)
What are the indications for bivalirudin?
PCI
HIT
What are the indications for argatroban?
PCI
HIT
What are the indications for warfarin?
Stroke Prophylaxis in patients with mechanical heart valves or mitral stenosis
VTE Prophylaxis/Treatment in patients with antiphospholipid syndrome or mechanical heart valves
What are the indications for fondaparinux?
VTE Prophylaxis/Treatment
What anticoagulant(s) can be used for stroke prophylaxis in nonvalvular patients?
Apixaban
rivaroxaban
edoxaban
dabigatran
What anticoagulant(s) can be used for DVT prevention in KNEE/HIP surgery?
Knee: apixaban, rivaroxaban
Hip: apixaban, rivaroxaban, dabigatran
Which anticoagulant(s) can be used for treatment of STEMI?
UFH
Enoxaparin
Which anticoagulant(s) can be used for treatment of ACS?
UFH
Which anticoagulant(s) can be used for treatment of UA/NSTEMI?
enoxaparin
dalteparin
Which anticoagulant provides reduced risk of major CVD events in patients with PAD or CAD?
rivaroxaban
Which anticoagulant is indicated for PCI?
argatroban
bivalirudin
Which anticoagulant is indicated for HIT?
argatroban
bivalirudin
Fondaparinux (off-label)
Heparin dosing:
Prophylaxis of VTE
5000 units SC Q8-12H
Heparin dosing:
VTE Treatment
80 units/kg bolus then 18 units/kg/hr
Heparin dosing:
ACS/STEMI
60 units/kg bolus then 12 units/kg/hr
Enoxaparin dosing:
VTE Prophylaxis
30 mg Q12h or 40 mg Q24h
if CrCl < 30: 30 mg Q24h
Enoxaparin dosing:
VTE Treatment or UA/NSTEMI
1 mg/kg Q12h or
For VTE Treatment Inpatient only:
1.5 mg/kg Q24h
if CrCl < 30: 1 mg/kg Q24h
Enoxaparin dosing:
STEMI and < 75 yo
30 mg bolus then 1 mg/kg Q12h
if CrCl < 30: 30 mg bolus then 1 mg/kg Q24h
Enoxaparin dosing:
STEMI and 75+ YO
NO BOLUS. 0.75 mg/kg Q12h
if CrCl < 30: NO BOLUS. 1 mg/kg Q24h
Apixaban dosing:
Nonvalvular AF Stroke Prophylaxis
5 mg BID
If 2/3 are met - SCr > 1.5; Age >80, Wt < 60 kg then 2.5 mg BID
Apixaban dosing:
DVT/PE Treatment
10 mg BID for 7 days then 5 mg BID
Do not dose reduce.
rivaroxaban dosing:
Nonvalvular Afib Stroke Prophylaxis
15-20 mg daily with EVENING meal
rivaroxaban dosing:
DVT/PE Treatment
15 mg BID x 21 days then 20 mg daily with food.
What if I miss my rivaroxaban dose?
If taking 2x daily: May double up, ensure 30 mg/day is taken then resume normal.
If taking 1x daily: Take when remember or skip. Do not double up. Then resume normal.
Edoxaban dosing
CrCl > 95: Contraindicated
DVT/PE Dosing:
Start after 5-10 days of parenteral anticoagulation
Dabigatran dosing
Treatment of DVT/PE:
Start after 5-10 days of parenteral anticoagulation
What if I miss my dabigatran dose?
Take dose unless within 6 hours of next dose. Do not double up.
Warfarin dosing:
Most people: 10 or less mg for first two days then adjust on INR
5 or less mg daily: for Elderly, malnourished, high bleed risk, liver impairment, HF, concurrent meds that raise INR
What are the safety considerations for heparin?
Contraindications: Active Bleed
Warnings: high risk for med errors, confirm correct concentration
Side Effects: bleeding, thrombocytopenia, HIT, hyperkalemia
What are the safety considerations for enoxaparin?
Boxed Warning: neuraxial anesthesia increases risk of hematoma and subsequent paralysis
Contraindication: Major active bleeding and history of HIT
Side effects: bleeding, anemia, injection site reactions of bruising/hematoma, and decreased platelets
What are the safety considerations for DIRECT Xa Inhibitors?
Boxed Warning: neuraxial anesthesia (spinal/epidural) increases risk of hematoma and subsequent paralysis
Contraindications: Active pathological bleeding
Warning: Not recommended for patients with mechanical heart valve or antiphospholipid syndrome
Side Effects: bleeding
What are the safety considerations of Fondaparinux?
Boxed Warning: neuraxial anesthesia (spinal/epidural) increases risk of hematoma and subsequent paralysis
Contraindication: Severe renal impairment (CrCl < 30)
Side effects: bleeding
What are the safety considerations of dabigatran?
Boxed Warning: neuraxial anesthesia (spinal/epidural) increases risk of hematoma and subsequent paralysis
Contraindication: Mechanical heart valves
Side Effects: Dyspepsia, gastritis-like symptoms, bleeding (GI bleeding)
What are the safety considerations of the IV Direct Thrombin Inhibitors?
Side Effects: bleeding
What are the safety considerations of warfarin?
Contraindications: Pregnancy (unless patient has mechanical heart valve)
Warnings: tissue necrosis/Gangrene, HIT, and pharmacogenomic considerations of increased bleed with CYP2C92 or CYP2C93 alleles or VKORC1 polymorphism
Side effects: bleeding/bruising, skin necrosis, purple toe syndrome
