Anticoagulation Drugs

Question 1

How long should anticoagulation therapy be administered in pt with unprovoked DVT/PE?

Answer 1

At least 3 months; consider indefinite if bleeding allows, use aspirin

Question 2

What is recommended length of anti-coagulant therapy in pt that had a cancer related DVT/PE?

Answer 2

As long as cancer is active

Question 3

What are 4 factors that place pt in high-risk category post-operatively?

Answer 3

• Recent major orthopedic surgery
• Abdominal/pelvic cancer surgery
• Spinal cord injury or major trauma within 90 days
• ≥3 intermediate risk factors

Question 4

What are 2 factors that place pt in low-risk category post-operatively?

Answer 4

• Minor procedure in age <40 without other risk factors
• Ambulatory with expected length of stay <24 hrs or minor surgery

Question 5

What are the 4 uses of LMWH (enoxaparin) post-operatively, including frequency of dosing and length of use?

Answer 5

1. Most medical pt’s and critical care pt’s
2. Many surgical pt’s (4 weeks in abdominal/pelvic cancer surgery)
3. Many ortho pt’s (2x daily; 10-day minimum; post-joint replacement up to 1 month in high risk pt’s)
4. Bariatric surgery (2x daily in this group)

Question 6

What is Fondaparinux used for clinically and for how long?

Answer 6

• Many ortho pt’s –> 10 day minimum
• Post-joint replacement up to 1 month in high-risk pt’s

Question 7

What is the indication for use of the DOAC’s, Rivaroxaban and Apixaban, including length of use?

Answer 7

• Ortho pt’s s/p THA or TKA
• Give for 12 days following total knee
• Give for 35 days following total hip

Question 8

What is the indication for using the DOAC, Dabigatran, including length of use?

Answer 8

• Ortho pt’s s/p THA
• Give only if CrCl is >30 mL/min

Question 9

What is the goal INR when using Warfarin in ortho pt’s and in which pt’s is it indicated + how long should it be used?

Answer 9

• Goal INR = 2.5; give for 10 days minimum
• High-risk pt’s s/p THA, TKA, or hip fractures consider up to 1 month of use