Anticoagulation Flashcards
At one point do you start to get concerned about troponin levels?
- in the 100s
____ failure will increase the troponin levels
renal
How long after an MI does the troponin stay positive?
- stays positive for the first 5-7 days
What is a type 2 MI?
- when you’ve worked harder than your coronary arteries can delivery oxygen - this can happen to marathon runners even
- when your myocardial cells die they release troponin - released when not enough oxygen gets to your heart
ST segment elevation is indicative of what?
- STEMI
What do STEMIS need?
- bypass surgery or emergency PCI
STEMIs have _____ thickness myocardial walls
full
NSTEMI has ____ thickness myocardial walls
partial
Is creatinine clearance ever set?
NO
- if the creatinine is increasing, then we say the creatinine clearance is decreasing (BAD)
- if the creatinine is decreasing, then we say that the creatinine clearance is increasing (GOOD)
If you are producing zero urine, what is your GFR?
you don’t have a GFR
you need to have urine production to have an active GFR
Apixiban right now is not recommended under what?
25 mL/min
What is the major question to be asked when thinking to start someone on ticagralor?
- if they have a bleed risk
- also if they can afford it
What is heparin reversed by?
- protamine
Are there any agents that are reversals for asa or clopridogrel?
NO
- have to let it wash out of the body
When would you not give a statin?
if you saw that the CKs were elevated
What are 2 things you should watch when you add an ACE inhibitor?
- watch kidney function and watch K
81 mg ASA will never cause a reduction in _________
renal prostagladins
- these have an effect on dilating the renal arteries
If you see a change in the Cr, get rid of ______
ACEI
When would you not give someone rosuvastatin?
- if you saw CKs elevated, you would not give a statin
With an ACE inhibitor, watch what?
- watch K and watch kidney function
What is the main risk behind using ASA alone?
have a higher risk of stent thrombosis
______ does nothing to prevent stent thrombosis
Clopridogrel
Leg clots are made up mostly of ______
fibrin
Why could you not use 2 anti platelets for a DVT?
- because leg clots are made up mainly of fibrin with little/no platelets
How long should a DOAC be used for after a STEMI?
- 3 months
How long should a DOAC be used for a.fib?
for LIFE
What would the benefit be of adding a PPi onto a DOAC?
- reducing the bleed risk
- need to be careful however, because the PPis inhibit the 2C19 enzyme and stop the metabolism of clopridogrel
How long would you keep someone on a PPi for?
- the duration that they are on triple therapy, and then you stop the PPi after that
What is the reversal agent for dabigitran?
- praxbind (idrucizumab)
What is andexante alpha?
- the Xa receptor binder that will replace the binding site for the DOAC
- should be able to have an anti-Xa monitoring agent
What DOAC has the least amount of bleeding risk of all?
apixiban
What DOAC has the higher risk of bleeding?
- rivaroxaban
What are the positive endpoints associated with tripe therapy
- resolution of and no chest pain
What are the negative endpoints that are associated with triple therapy?
- presence of blood in the stool or urine, nose bleeds, bruising, cuts that take a long time to heal, or headache that is worse than normal
What lab tests do we need to measure when giving someone triple therapy?
- platelets, hemoglobin, and creatinine, urea and WBC
How does renal failure cause bleeding
increase in urea makes platelets dysfunctional and can make the person bleed severely
What are very important counselling points to educate a patient on when they’re using triple therapy?
- avoid use of NSAIDs
- inform all HCPs that you are using an anticoagulant/ anti platelet
- educate on s/s of bleeding
- avoid contact sports
- monitor alcohol intake (can increase risk of bleeding)
- avoid herbal products that exacerbate the bleeding (St. John’s Wort for example)
- don’t miss a dose, and don’t double dose if you forget
