Anticoagulation in special populations Flashcards
What populations would need special consideration if they are to receive anticoagulation
Pregnancy, Renal insufficiency, Extremes of body weight, Patients with cancer
What are indications that would put a pregnant women on anticoagulants
Prophylaxis against VTE and arterial thrombosis, Treatment of thrombosis during pregnancy, prevention of pregnancy loss
What are high risk circumstances that would lead a women to be advised to not get pregnant
mechanical heart valves, chronic thromembolic pulmonary hypertension, history of recurrent thrombosis while fully anticoagulated, history of MI
T/F: If a patient is on anticoagulants before pregnancy they will need to be on some type of anticoagulant during pregnancy
True
What is the best anticoag to give to a pregnant patient
LMWH
T/F: If a patient is on anticoagulants they should also be off estrogen containing birth control because their risk for clot is increased
False: If a patient is on anticoagulants they can’t be on combined estrogen birth controls
When is LMWH the best option for pregnant patients, What other times during pregnancy is LMWH acceptable
First trimester, during late pregnancy when delivery is imminent, second and third trimesters
When is Heparin better for pregnant patients
Patient has severe renal dysfunction
When would fondaparinux be better for patients
Allergies to LMWH/Heparin or history of heparin induced thrombocytopenia
What are the prophylacitic LMWH doses for pregnant women, intermediate dose LMWH
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
How long should postpartum anticoagulation be
At least 6 weeks
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
True
When is warfarin the most dangerous for a fetus
First 6-12 weeks
When is the ONLY circumstance a pregnant patient would be given warfarin, what dose must it be
Patient has a mechanical heart valve, less than 5 mg
T/F: If a patient is receiving anesthesia than their anticoagulant should be stopped immediately
True
What are the safe anticoagulant options for breastfeeding
Warfarin, Heparin, LMWH
What kidney monitoring parameter is associated with a higher risk of bleeding, what is the value
Scr, greater than 1.5 mg/dl
What other heart condition becomes more likely with worsening kidney function
Atrial fibrillation
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
Enoxaparin, Dalteparin, Tinzaparin, Heparin/Fondaparinux, excreted 100% through the urine
T/F: Caution in using LMWH becomes apparent at a CrCl of less than or equal to 50
False: Caution in using LMWH becomes apparent at a CrCl of less than or equal to 30
What is the enoxaparin prophylaxis dose for a patient with a CrCl less than 30, treatment
30 mg SC daily, 1 mg/kg SC daily
What is the best anticoagulant to give someone with renal insufficiency, why
Heparin, eliminated by the liver
What is monitored for efficacy in warfarin, Heparin, LMWH
INR, aPTT, Anti-Factor Xa
What is monitored for safety in warfarin, Heparin, LMWH and DOACs
INR, CBC, LFTs/ Platelet count/ Anti-factor Xa, Platelet count, Scr/ Scr and CBCs
Which DOAC is most reliant on renal elimination, which is not
Dabigatran, Apixiban
T/F: DOACs are safe to use in ESRD
False: DOACs are contraindicated in ESRD as they cause a higher risk of bleeding
Which DOAC should not be used if the CrCl is greater than 95
Edoxaban
What is the best DOAC to give if a patient is on dialysis
Apixiban
What are the best ANTICOAGULANT choices for patients with renal clearance less than 30
Heparin, Warfarin, Argatroban, Apixaban
When someone is at extremes of body weight how is dosing done in Heparin and LMWH
Use total body weight
T/F: Warfarin can be given no matter the weight therefore it is the best option
True
T/F: There are no recommendations for changing the dose for DOACs
True
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
What are the treatment options for treating cancer patients with a high risk of bleeding, low risk of bleeding
LMWH, Edoxaban or Rivaroxaban
What anticoagulants can be used regardless of kidney function
Warfarin and Heparin
What is the weight cap for using DOACs
120 kg
