Anticoagulation guidelines SA

Question 1

Name patient risk factors for VTE?

Name procedure related risk factors ?

Answer 1

• age >60 years
• history of VTE
• immobility
• underlying malignancies
• pregnancy
• oestrogen therapy
• obesity
• hereditary thrombophilic state
• inflammatory bowel disease
• HIV/AIDS
• auto-immune diseases including antiphospholipid syndrome
  duration of the procedure
• degree of tissue damage (orthopaedic/trauma surgery carries
  the greatest risk)
• degree of immobility following surgery
• nature of the surgical procedure (e.g. lower limb orthopaedic
  surgery, neurosurgery, etc.).

Question 2

Name options for prophylactic anticoagulation in category

Low risk procedure

Higher risk procedure with no risk factors

High risk procedure with risk factors

Question 3

Timing of prophylaxis ?

When is ideal time ?
Can it be given post op ?

And duration of prophylaxis ?

Answer 3

1.2.3 Timing of prophylaxis
NOTE: This is extremely controversial.
* Data are available confirming the benefits of prophylactic
anticoagulation initiated pre-operatively.
* Although pre-operative initiation of prophylactic anticoagulation
is desirable, there are data indicating that starting prophylaxis
postoperatively is adequate. It should be given postoperatively
within 6 - 12 hours, i.e. NOT before 6 hours postoperatively and
NOT after 12 hours postoperatively, provided no active bleeding
is present. For major hip and knee surgery, a postoperative
initiation time of 12 hours appears to be optimal.
* Adjustment of the dose in patients with renal failure is mandatory
(refer to package inserts of individual drugs).
1.2.4 Duration of prophylaxis
* General recommendations:
* major cancer surgery: 5 weeks
* hip replacement surgery: 5 weeks
* knee replacement surgery: 2 weeks.
* LMWH prophylaxis should be continued until patient is fully
mobile.
* For major surgery in patients with additional risk factors or very
high-risk procedures (major orthopaedic surgery), at least 7 - 10
days’ prophylaxis is indicated.
* Extended out-of-hospital prophylaxis (up to 1 month) with
LMWH or warfarin started immediately postoperatively, and
adjusted to maintain an international normalised ratio (INR) of
2 - 3, has been shown to provide additional benefit.

Question 4

How to monitor patients on
LMWH?
DOACS?

Question 5

How to manage bleeding patients?

Answer 5

Question 6

Treatment VTE

What to start?
For how long
When to start warfarin ?
How long to give LMWH PE ?

Answer 6

Question 7

Duration of oral anticoag?

Answer 7

Question 8

Indications for venocaval filters ?

Answer 8

• recurrent VTE despite adequate anticoagulation
• contraindications to anticoagulation such as head injury
• clinical benefit has recently been documented in haemodynamically
  unstable patients with pulmonary emboli.

Question 9

VTE predisposing risk factors ?

Answer 9

Question 10

Anticoagulation reversal :
General principles?
Group bleeding in 3 groups of reversal situations ?
Name reversal agents ?

Answer 10

Question 11

Reversal of the following :
1.LMWH UFH
2.Warfarin
3. Antiplatelets therapy

Answer 11