Anticoagulation 2 Flashcards
How is warfarin bridge to other anticoagulants (READ)
Rivaroxaban: Stop warfarin when INR is 3 or less
Edoxaban: Stop warfarin when INR is 2.5 or less
Apixaban: Stop warfarin when INR is 2 or less
Dabigatran: Stop warfarin when INR is 2 or less
How are oral Xa inhibitors bridged to warfarin
1) Overlap Xa inhibitor with warfarin until INR is therapeutic
2) Stop Xa and start parenteral anticoagulation and warfarin at the same time
How is warfarin started in healthy patients
10 mg a day for 2 days then adjusted based on INR
What is the usual goal INR, mechanical valves
2 to 3, 2.5 to 3.5
What enzyme is affected by warfarin
CYP2C9
What are Herbal/Natural Products that increase INR (HINT: 5Gs)
Ginseng, Ginkos, Garlic, Glucosamine, Ginger
How is warfarin therapy used for DVT/PE when it is being used with a parenteral anticoagulation (Heparin and LMWH)
Same day as parenteral therapy: Continue anticoagulation for a minimum of 5 days until the INR is greater than or equal to 2 for 24 hours
If a patient opens a bottle of pradaxa how long do they have to take it
120 days (4 months)
What can be used to test Heparin efficacy
AntiXa and APPT
What drug should be avoided if a person has extremely good renal function
Edoxaban
If a person has had a DVT and they are taking Warfarin what is the goal INR, how long should they take it
2-3 for 3 months
What are the drugs associated as CYP2C9 inhibitors, therefore increasing the risk of bleeding with Warfarin use (HINT: MAT)
M: Macrolides, metronidazole
A: Azoles, amiodarone
T: TMP/SMX (Bactrim)
If the INR is out of range but there is no major bleeding what should be done
Warfarin doses can be skipped until INR is corrected
If the INR is out of range and greater than 10 what should be done
Hold warfarin and Give oral Vitamin K 2.5 to 5 mg EVEN IF NOT BLEEDING
If the patient is having a major bleed and is on warfarin what should be done
Give Vitamin K 5 to 10 mg by slow IV injection AND 4 Factor prothrombin complex concentrate (4PCC)
What are the LMWH
Enoxaparin and Dalteparin
What is the antidote for Warfarin
Mephyton/Phytonadione (Vitamin K)
What are the benefits of LMWH over Heparin
Do not require routine monitoring, LMWHs are cost effective, more predictable response
When is LMWH usually monitored
Pregnant patients, patients with extreme body weight, patients with renal impairment
What is a long term side effect of using Heparin
Osteoperosis
What are the CYP 2C9 inducers
Phenytoin, Rifampin, carbamezapine, St. John’s Wart
What do the CYP 2C9 inducers do when a patient is concurrently taking Warfarin
Decreases INR increasing the risk of clotting
For patients who are traveling what is the best way to prevent VTE if traveling
Calf exercise
T/F: Major surgery can increase the risk of clotting
True
If a patient is having Heparin-Induced Thrombocytopenia what are the steps that should be taken
Stop the Heparin/LMWH
Stop Warfarin if being given
Administer Vitamin K if warfarin was also given
(DON’T GIVE PLATELETS)
T/F: Do not expel air bubbles from Enoxaparin when administering
True
What does the CHADsVASC score tell you
Relative risk of stroke due to Atrial Fibrillation
When treating an acute DVT with dabigatran (PRADAXA) or Edoxaban (Saveysa) what does the labeling for each drug state for use
Approved for use AFTER 5 to 10 days of parenteral anticoagulat
What DOACs can be used for DVT without bridging
Apixaban and Rivaroxaban
