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Pharm 3 (me) > Antithrombotics > Flashcards

Antithrombotics Flashcards

1
Q

Interruption of anticoagulation temporarily increases what?

A

Thromboembolic risk

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2
Q

Continuing anticoagulation increases risk of what?

A

Bleeding

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3
Q

What 2 things do you estimate to determine if and when to interrupt anticoagulation?

A
  1. Thromboembolic risk

2. Bleeding risk

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4
Q

3 high risk thrombotic risk stratification of mechanical heart valves?

A
  1. Any mitral valve prosthesis
  2. Older aortic valve prosthesis
  3. Recent (w/n 6mths) stroke or TIA
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5
Q

Moderate risk thrombotic risk stratification of mechanical heart valves?

A
  1. Bileaflet aortic valve and at least one of:

2. Afib, prior stroke or TIA, HTN, DM, CHF, >75

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6
Q

Low risk thrombotic risk stratification of mechanical heart valves?

A
  1. Bileaflet aortic valve w/o afib and no other risk factors for stroke
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7
Q

3 high risk thrombotic risk stratification of afib?

A
  1. CHA2DS2-VASc score >7
  2. Recent (w/n 3mths) thromboembolism
  3. Rheumatic valvular heart disease
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8
Q

2 moderate risk thrombotic risk stratification of afib?

A
  1. CHA2DS2-VASc score 5-6

2. Prior thromboembolism > 3mths previously

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9
Q

2 low risk thrombotic risk stratification of afib?

A
  1. CHA2DS2-VASc score 0-4

2. No prior thromboembolism

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10
Q

What 2 things cause CHA2DS2-VASc score of 2?

A

> 75 and stroke/TIA/thromboembolism

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11
Q

2 high risk thrombotic risk stratification of venous thromboembolism?

A
  1. Recent VTE (<6mths)

2. Severe thrombophilia (antiphospholipid antibodies)

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12
Q

4 moderate risk thrombotic risk stratification of venous thromboembolism?

A
  1. VTE within past 3-12 months
  2. Non-severe thrombophilia (heterozygous factor V mutation)
  3. Recurrent VTE
  4. Active cancer (treated w/n 6mths or palliative)
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13
Q

Low risk thrombotic risk stratification of venous thromboembolism?

A

Priori VTE >12 mths ago and no other risk factors

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14
Q

Annual stroke risk for high, moderate, and low risk?

A

High ( >10%)
Moderate (5-10%)
Low (<5%)

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15
Q

Annual risk of VTE for high, moderate, and low?

A

High (>10%)
Moderate (5-10%)
Low (<5%)

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16
Q

8 low/very low risk periop bleeding

A
  1. Dental extraction
  2. Subgingival scale/cleaning
  3. Cataract
  4. Dermatological
  5. Gastroscopy/colonoscopy with and without biopsy
  6. Coronary angiography
  7. Pacemaker/defibrillator
  8. Select procedures (thoracentesis, paracentesis, arthrocentesis)
17
Q

8 moderate risk periop bleeding

A
  1. Intra-abdominal surgery
  2. General surgery (breast)
  3. Intrathoracic surgery
  4. Orthopedic surgery
  5. Vascular surgery
  6. Non-cataract ophthalmologic surgery
  7. Selected procedures (bone marrow biopsy, lymph node biopsy)
  8. Complex dental (multi tooth extraction)
18
Q

11 high risk periop bleeding

A
  1. Neuraxial anesthesia
  2. Neurosurgery
  3. Cardiac surgery
  4. Major intra abdominal surgery
  5. Major vascular surgery
  6. Major orthopedic surgery
  7. Lung resection surgery
  8. Urological surgery
  9. Extensive cancer surgery
  10. Reconstructive plastic surgery
  11. Selected procedures (kidney biopsy, prostate biopsy, cervical cone biopsy, pericardiocentesis, colonic polypectomy)
19
Q

When should an anticoagulation be interrupted?

A

Intermediate high surgical bleeding risk

20
Q

What does interrupt therapy mean?

A

Limit the period without anticoagulation to the shortest possible interval

  • especially thromboembolic risk is high
  • if high risk of thromboembolism is transient within 1 mth
21
Q

When do you consider interruption?

A

Low surgical bleeding risk AND presence of pt related bleeding factors

22
Q

When do you not interrupt anticoagulation?

A

Low bleeding risk surgery AND absence of pt related bleeding factors

23
Q

Discontinue >5 days before procedure depending on current INR, time to procedure; and desired INR for procedure; recheck INR 24 hrs before procedure

A

Supratherapeutic INR measure 5-7 days prior to procedure

24
Q

Discontinue 5 days before procedure depending on current INR, time to procedure and desired INR for procedure; recheck INR 24 hrs before procedure

A

Goal level of INR (2-3)

25
Q

Discontinue 3-4 days before procedure; recheck INR 24 hrs before procedure if a normal INR is desired

A

Subtherapeutic level for INR

26
Q

When considering parenteral bridging, if taking a direct oral anticoagulant (DOAC) is there a bridging needed?

A

NO

27
Q

What are the 3 parental agents for bridging?

A
  1. UFH
  2. LMWH
  3. Non heparin anticoagulant needed for HIT
28
Q

When do you start parenteral bridging?

A

INR <2

29
Q

When do you discontinue UFH?

A

4 hrs before procedure

30
Q

When do you discontinue LMWH?

A

24 hrs before procedure

31
Q

When to restart warfarin and when do you get anticoagulant effect?

A

Restart 12-24 hrs post op

2-3 days for effect

32
Q

If pt received parenteral bridge, start LMWH or UFH when for low and high bleeding risk and when should you discontinue LMWH or UFH?

A

Low risk: 24 hrs
High risk: 48-72 hrs
INR >2

33
Q

Restarting DOAC for low and high bleeding risk and how is the onset of action for drug?

A

Low: <24 hrs
High: 48-72 hrs
Onset: ~2-3 hrs

34
Q

What should be carefully monitored when restarting DOAC post procedure?

A

Renal function

35
Q

IV heparin should be stopped and restarted when for pain procedures?

A

Stop: 6 hrs
Restart: 2 hrs

36
Q

LMWH therapeutic and prophylactic dose stop, and when should it be restarted for low and moderate/high risk pain procedures?

A

Therapeutic: 24 hr
Prophylactic: 12 hr
Low risk: 4 hrs
Mod/high: 12 hrs

37
Q

When should fondaparinux be stopped and restarted for pain procedures?

A

Stop: 4 days
Restart: 6-24 hrs

38
Q

DOACs half life interval between D/C and procedure for neuraxial anesthesia ?

A

5 half life

39
Q

Warfarin stop and restart for neuraxial anesthesia?

A

Stop: 5 day before and INR <1.2
Restart: next day

Pharm 3 (me) (7 decks)

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