Anticoagulation and Blood Disorders - Anticoagulation

Question 1

Which heparin has equal Xa and IIa activity?

Answer 1

Unfractionated heparin

Question 2

Which clotting factor does low molecular weight heparin provide more activity to?

Answer 2

Xa

Question 3

Heparin MOA

Answer 3

Inhibits thrombin and factor Xa through antithrombin

Question 4

Heparin Prophylaxis VTE Dosing

Answer 4

5,000 U SQ q8-12h

Question 5

Heparin Treatment of VTE Dosing

Answer 5

80 units/kg IV bolus, 18 units/kg/hr infusion

Question 6

Heparin Treatment of ACS/STEMI Dosing

Answer 6

60 units/kg bolus, 12 units/kg/hr infusion

Question 7

Heparin side effects

Answer 7

Bleeding, thrombocytopenia, hyperkalemia, osteoporosis

Question 8

How often must aPTT or anti-xa levels be monitored with heparin

Answer 8

Every 6 hours after dose change, every 24 hours once therapeutic

Question 9

Low Molecular Weight Heparin Prophylaxis VTE Dosing

Answer 9

30 mg SQ q12h or 40 mg SQ daily. IF CrCl <30 mL/min 30 mg SQ daily

Question 10

Low Molecular Weight Heparin dosing treatment of VTE and Unstable Angina/NSTEMI

Answer 10

1 mg/kg SQ q12h or 1.5 mg/kg SQ daily. IF CrCl <30 mL/min 1 mg/kg daily

Question 11

Low molecular weight heparin treatment of STEMI pt <75 years old

Answer 11

30 mg IV bolus, plus 1 mg/kg SQ dose followed by 1 mg/kg Q12 h. IF CrCl <30: 30 mg IV bolus plus 1 mg/kg dose followed by 1 mg/kg SQ daily

Question 12

Low molecular weight heparin treatment of STEMI in pt > 75

Answer 12

0.75 mg/kg SQ q12 h. IF CrCl <30 1 mg/kg SQ daily

Question 13

What is the boxed warning for enoxaparin

Answer 13

Concomitant use with neuraxial anesthesia

Question 14

When is monitoring required for enoxaparin?

Answer 14

Extremes in body weight, reduced kidney function or pregnancy. Draw level 4-6 hours after SQ dose

Question 15

Heparin Induced Thrombocytopenia

Answer 15

4 Ts Score:
Thrombocytopenia
Timing of platelet count fall
Thrombosis
oTher causes of thrombocytopenia

Question 16

What treamtent to use if pt has HIIT

Answer 16

Start a non-heparin anticoag (argatorban or bivalirudin)

Question 17

Rivoraxaban dosing stroke prophy

Answer 17

CrCl >50 mL/min: 20 mg PO with evening meal
CrCl 15-50 mL/min: 15 mg PO with evening meal
CrCl <15 mL/min: Avoid use

Question 18

Rivaroxaban treatment of VTE dosing

Answer 18

15 mg PO BID for 21 days, then 20 mg PO daily with food
If CrCl < 30 mL/min avoid use

Question 19

Missed Dose Instructions DOACs

Answer 19

Apixaban or edoxaban: take it immediately on the same day that the drug is missed and then resume normal schedule
Rivaroxaban: If taking 15 mg BID, take it immediately even if 2 tabs may be taken at once, if taking once daily take immeidately on same day otherwise skip dose

Question 20

Fondaparinux contraindication

Answer 20

Severe renal impairment