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BNF Cardiovascular > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Why are anticoagulants used for venous circulation?

A

Blood is faster moving and thrombi are composed of platelets and little fibrin ( as in arteries)

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2
Q

Example of a Vit K antagonist

A

Warfarin / Acenocoumarol / Phenidione

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3
Q

Onset of action for Warfarin

A

48-72 hours

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4
Q

If an immediate effect of Warfarin is needed what does the BNF suggest we do?

A

Bridge with LMWH for 5 days or until INR >2

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5
Q

What 2 conditions can Warfarin not be used in?

A

Cerebral artery thrombus and peripheral artery occlusion (first line = aspirin)

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6
Q

Target INR for treatment of DVT / PE

A

2.5

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7
Q

Target INR for AF

A

2.5

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8
Q

Target INR for dilated cardiomyopathy

A

2.5

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9
Q

Target INR for MI

A

2.5

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10
Q

Target INR for recurrent DVT / PE

A

3.5

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11
Q

Target INR for prosthetic heart valves

A

3.5

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12
Q

Duration of Warfarin treatment in provoked VTE

A

3 monthd

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13
Q

Duration of Warfarin treatment in isolated calf DVT

A

6 weeks

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14
Q

Duration of Warfarin treatment in unprovoked DVT /PE

A

3 months (6 months to long term possible)

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15
Q

Duration of Warfarin treatment in AF / Heart valves

A

Long term

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16
Q

What does the BNF suggest doing to Warfarin if there is haemorrhage?

A

Check INR, Omit dose if necessary, consider reversal agents

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17
Q

If a patient has a major bleed on warfarin what does the BNF suggest to do?

A
  1. stop warfarin 2. Phytomenidione by slow IV 3. dried prothrombin complex / fresh frozen plasma
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18
Q

If a patients INR is >8 and they are on Warfarin what do you do?

A

Stop warfarin, give phytomenidione and repeat if INR is still too high. Restart Warfarin when INR < 5

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19
Q

If a patient has an INR of 5-8 with no bleeding on Warfarin - what do you do?

A

Omit warfarin for 1 to 2 doses

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20
Q

How many days before surgery should Warfarin be stopped?

A

5 days

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21
Q

If you have a Warfarin patient where surgery cannot be delayed and INR >1.5 what do you do?

A
  1. If can delay for 6 - 12 hours give IV Vit K

2. If cant delay dried prothrombin complex + Vit K + check INR

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22
Q

Benefit of Heparin

A

Short half life so can be terminated quickly

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23
Q

Benefit of LMWH

A

Lower risk of osteoporosis + HIT, no standard montioring, OD dosing

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24
Q

What anticoagulation medication can be used if a patient has HIT?

A
  1. Danaparoid - used for HIT patients
  2. Argatroban - can be started when thrombocytopenia has resolved
  3. Fondaparinux
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25
Q

Dose of apixaban for stroke prevention in NVAf

A

5mg BD longterm, reduce to 2.5mg BD if patient has 2 of the 3 factors

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26
Q

When would you reduce the dose of Apixaban when treating for stroke prevention?

A

If the patient is 1. >80 2. <60kg 3.Cr >133

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27
Q

Treatment dose of Apixaban

A

10mg BD for 7 days, reduce to 5mg BD for at least 3 months

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28
Q

Dose of Apixaban for prevention of recurrent DVT / PE

A

2.5mg BD

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29
Q

Dose of Apixaban for prevention of VTE in hip replacement

A

2.5mg BD after 12 to 24 hours of surgery. Treat for 32-38 days

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30
Q

Dose of Apixaban for prevention of VTE in knee replacement

A

2.5mg BDafter 12 to 24 hours of sugery for 10 - 14 days

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31
Q

At what renal function is Apixaban contraindicated?

A

CrCl<15 ml/min

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32
Q

Dose of Dabigatran for prevention of VTE in hip replacement

A

220mg OD for 28 to 35 days

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33
Q

Dose of Dabigatran for prevention of VTE in knee replacement

A

220mg OD for 10 days

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34
Q

Dose of Dabigatran for prevention of VTE in stroke prophylaxis

A

150mg BD (reduce to 110mg BD if >80 or on verapamil/amiodarone)

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35
Q

Treatment dose of Dabigatran for VTE

A

150mg BD for at least 3 months

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36
Q

At what CrCL is Dabigatran contraindicated?

A

<30ml/min

37
Q

MHRA warning for DOACS

A

Increased risk of thrombotic events if patient has antiphospholipid syndrome

38
Q

Reversal agent for Dabigatran

A

Idarucizumab

39
Q

Dose of Edoxaban in stroke prophylaxis

A

60mg OD for long term

40
Q

Dose of Edoxaban for treatment of DVT / PE

A

Post 5 days of parenteral, give 60mg OD for at least 3 months

41
Q

Whst is the creatinine cut off for Edoxaban?

A

Crcl <15 ml/min

42
Q

How should Rivaroxaban be taken?

A

With food

43
Q

Dose of Rivaroxaban for prevention of VTE in hip replacement

A

10mg OD starting 6 to 10 hours post surgery for 35 days

44
Q

Dose of Rivaroxaban for prevention of VTE in knee replacement

A

10mg OD starting 6 - 10 hours post surgery for 14 days

45
Q

Dose of Rivaroxaban for prevention of stroke in NVAF

A

20mg OD longterm

46
Q

Dose of Rivaroxaban in treatment of DVT or PE

A

15mg BD for 3 weeks then 20mg OD for at least 3 months

47
Q

Dose of Rivaroxaban for prevention in recurrent DVT/PE

A

15mg BD for 3 weeks followed by 20mg OD for 3 months

48
Q

Dose of Rivaroxaban in prevention of atherothrombotic events post ACS

A

2.5mg BD (+aspirin) for 12 months

49
Q

What is the CrCl cut off for Rivaroxaban?

A

CrCl<15 ml/min

50
Q

Antidocte for apixaban / Rivaroxaban

A

Andexant aloha (recombinant human factor Xa)

51
Q

What is the mechansim of action behind antiplatlet drugs?

A

Reduce platelet aggregation and inhibit thrombus formation in arteries

52
Q

Examples of antiplatlet drugs

A

Aspirin, Clopidogrel, Ticagrelor

53
Q

If a patient has an NSTEMI how long should clopidogrel be given for?

A

3 months (+ aspirin)

54
Q

If a patinet has a STEMI how long should Clopidogrel be given for?

A

4 weeks ( + low dose aspirin)

55
Q

Contraindications for Aspirin

A

< 16 years ( Reyes syndrome risk), active peptic ulceration,haemophillia

56
Q

Features of Aspirin overdose

A

Tinnitus, deafness, vasodilation, hyperventilation, sweating

57
Q

In adults, when no strength is stated what should be dispensed?

A

300mg aspirin tablets

58
Q

How many aspirin can be sold OTC?

A

pack size of 32 capsules or tablets. Pharmacists can sell up to 100 caps or tablets in justifiable circumstances

59
Q

Warning labels for Aspirin

A

Take with food, Contains aspirin, Do not crush or chew

60
Q

How many days before elective surgery should Clopidogrel be stopped?

A

7 days

61
Q

Why do dipyridamole capsules need to be dispensed in the original container?

A

They contain desiccant in the pack . Any remaining capsules should be discarded after 6 weeks

62
Q

Maximum dose of Edoxaban if given alongside Dronedarone/Ciclosporin/ erythromycin etc

A

30mg OD

63
Q

MHRA alert for Rivaroxaban

A
  1. DOACs + risk of antiphospholipid syndrome

2. Must be taken with food to increase efficacy

64
Q

At what body weight is Rivaroxaban cautioned?

A

<60kg

65
Q

What medication can be used as an adjunct to thromboprophylaxis associated with prosthetic valves

A

Dipyramidole (MR preparation are licensed for secondary prevention of ischemic stroke + TIA)

66
Q

When is prasugrel + aspirin or Ticagrelor + aspirin used in combination and for how long?

A

prevention of atherosclerotic events in patients with ACS for 12 months

67
Q

When is Cangrelor used?

A

In combination with aspirin for the reduction in thrombotic cardiovascular events in patients with CAD undergoing PCI who have not received treatment wiht oral clopidogrel,prasugrel or Ticagrelor and in whom these drugs are not suitable

68
Q

What antiplatlet therapy is required for patients who are selected for PCI with the placement of a coronary stent?

A

DAPT (asprin + clopi/ticagrelor/prasugrel/cangrelor)

Aspirin should continue indefinitely

69
Q

Following PCI, how long should a patient with a bare-metal stent receive clopidogrel for?

A

1 month

70
Q

Following PCI, how long should a patient with a drug elluting-metal stent receive clopidogrel for?

A

6 months

71
Q

How do Glycoprotein IIb/IIA inhibitors work?

A

prevent platelet aggregation by blocking the binding of fibrinogen to receptors on platelets

72
Q

Examples of Glycoprotein IIb/IIa inhibitors

A

Abciximab, Eptifibatide, Tirofiban

73
Q

What is Abiciximab licensed for?

A

as an adjunct to heparin (unfractionated) and aspirin for the prevention of ischemic complications in highrisk patients undergoing PCI. Abiciximab should be used ONCE only

74
Q

What are Tirofiban and Eptifibatide licensed for?

A

prevent early MI in patients wiht unstable angina or NSTEMI

75
Q

What dose of Clopidogrel is given for prevention of atherosclerotic events in PCI?

A

300mg STAT prior to procedure

76
Q

What dose of Clopidogrel is suggested for prevention of atherosclerotic events in ACS (NSTEMI)

A

300mg STAT, 75mg OD for 12 months

77
Q

What dose of Clopidogrel is suggested for prevention of atherosclerotic events in ACS (STEMI)

A

300mg STAT, 75mg OD for 4 weeks at least

78
Q

What are the signs of Heparin induced thrombocytopenia?

A

30% reduction in platelet count, skin allergy, thrombosis. Stop heparin, use an alternative anticoagulant e.g. Danaparoid

79
Q

How can heparin cause hyperkalaemia

A

Inhibition of aldosterone secretion

80
Q

What patients are more at risk of hyperkalaemia from Heparin?

A

Patient with diabetes, chronic renal failure, raised plasma potassium, taking potassium sparring drugs

81
Q

If anti-factor Xa levels are needed, when should they be taken?

A

3 to 4 hours post dose ( aim for anti-factor Xa 0.5-1unit/mL)

82
Q

Dose of Enoxaparin for tx of DVT if <50kg

A

40mg BD

83
Q

Dose of Enoxaparin for tx of DVT if 50 - 69kg

A

60mg BD

84
Q

At what CrCl should Tinzaparin be avoided

A

<30ml/min

85
Q

What is urokinase most commonly used for?

A

Occluded central venous catherters (blocked by fibrin clots)

86
Q

What class of anticoagulants can direct acting antivirals interact with (MHRA alert)

A

Vitamin K antagonists - risk of changes to INR monitor closely

87
Q

What anticoagulant is teratogenic?

A

Warfarin - warned women of child bearing potential about the risks

88
Q

Why should patients be warned to contact their Drs if they develop a painful skin rash on warfarin?

A

MHRA alert - risk of calciphylaxis with Warfarin. Most commonly observed in patients wiht known risk factors e.g. end stage renal disease

BNF Cardiovascular (10 decks)

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