Anticoagulation in special populations Flashcards

1
Q

What populations would need special consideration if they are to receive anticoagulation

A

Pregnancy, Renal insufficiency, Extremes of body weight, Patients with cancer

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2
Q

What are indications that would put a pregnant women on anticoagulants

A

Prophylaxis against VTE and arterial thrombosis, Treatment of thrombosis during pregnancy, prevention of pregnancy loss

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3
Q

What are high risk circumstances that would lead a women to be advised to not get pregnant

A

mechanical heart valves, chronic thromembolic pulmonary hypertension, history of recurrent thrombosis while fully anticoagulated, history of MI

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4
Q

T/F: If a patient is on anticoagulants before pregnancy they will need to be on some type of anticoagulant during pregnancy

A

True

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5
Q

What is the best anticoag to give to a pregnant patient

A

LMWH

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6
Q

T/F: If a patient is on anticoagulants they should also be off estrogen containing birth control because their risk for clot is increased

A

False: If a patient is on anticoagulants they can’t be on combined estrogen birth controls

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7
Q

When is LMWH the best option for pregnant patients, What other times during pregnancy is LMWH acceptable

A

First trimester, during late pregnancy when delivery is imminent, second and third trimesters

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8
Q

When is Heparin better for pregnant patients

A

Patient has severe renal dysfunction

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9
Q

When would fondaparinux be better for patients

A

Allergies to LMWH/Heparin or history of heparin induced thrombocytopenia

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10
Q

What are the prophylacitic LMWH doses for pregnant women, intermediate dose LMWH

A

Dalteparin 5000 units SC every 24 hours, Enoxaparin 40 mg SC every 24 hours/ Dalterparin 5000 units SC every 12 hours, Enoxaparin 40 mg SC every 12 hours

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11
Q

How long should postpartum anticoagulation be

A

At least 6 weeks

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12
Q

T/F: Aspirin crosses the placenta and should only be used in 81 mg tablets and to treat preclampsia but should be avoided in the last week

A

True

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13
Q

When is warfarin the most dangerous for a fetus

A

First 6-12 weeks

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14
Q

When is the ONLY circumstance a pregnant patient would be given warfarin, what dose must it be

A

Patient has a mechanical heart valve, less than 5 mg

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15
Q

T/F: If a patient is receiving anesthesia than their anticoagulant should be stopped immediately

A

True

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16
Q

What are the safe anticoagulant options for breastfeeding

A

Warfarin, Heparin, LMWH

17
Q

What kidney monitoring parameter is associated with a higher risk of bleeding, what is the value

A

Scr, greater than 1.5 mg/dl

18
Q

What other heart condition becomes more likely with worsening kidney function

A

Atrial fibrillation

19
Q

Rank the renal elimination of the LMWHs and Heparin from most renally eliminated to least renally eliminated, what anticoagulant can NEVER be used in a patient with bad renal function and why

A

Enoxaparin, Dalteparin, Tinzaparin, Heparin/Fondaparinux, excreted 100% through the urine

20
Q

T/F: Caution in using LMWH becomes apparent at a CrCl of less than or equal to 50

A

False: Caution in using LMWH becomes apparent at a CrCl of less than or equal to 30

21
Q

What is the enoxaparin prophylaxis dose for a patient with a CrCl less than 30, treatment

A

30 mg SC daily, 1 mg/kg SC daily

22
Q

What is the best anticoagulant to give someone with renal insufficiency, why

A

Heparin, eliminated by the liver

23
Q

What is monitored for efficacy in warfarin, Heparin, LMWH

A

INR, aPTT, Anti-Factor Xa

24
Q

What is monitored for safety in warfarin, Heparin, LMWH and DOACs

A

INR, CBC, LFTs/ Platelet count/ Anti-factor Xa, Platelet count, Scr/ Scr and CBCs

25
Which DOAC is most reliant on renal elimination, which is not
Dabigatran, Apixiban
26
T/F: DOACs are safe to use in ESRD
False: DOACs are contraindicated in ESRD as they cause a higher risk of bleeding
27
Which DOAC should not be used if the CrCl is greater than 95
Edoxaban
28
What is the best DOAC to give if a patient is on dialysis
Apixiban
29
What are the best ANTICOAGULANT choices for patients with renal clearance less than 30
Heparin, Warfarin, Argatroban, Apixaban
30
When someone is at extremes of body weight how is dosing done in Heparin and LMWH
Use total body weight
31
T/F: Warfarin can be given no matter the weight therefore it is the best option
True
32
T/F: There are no recommendations for changing the dose for DOACs
True
33
What are the two DOACs that can be used in cancer patients with VTE, what is the risk
Edoxaban and Rivaroxaban, increased risk of bleeding with lower risk of clotting
34
What are the treatment options for treating cancer patients with a high risk of bleeding, low risk of bleeding
LMWH, Edoxaban or Rivaroxaban
35
What anticoagulants can be used regardless of kidney function
Warfarin and Heparin
36
What is the weight cap for using DOACs
120 kg