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Cardiovascular > Bleeding Risk > Flashcards

Bleeding Risk Flashcards

1
Q

Tranexamic acid class

A

Antifibrinolytic drug which reduces or prevents bleeding by impairing fibrin dissolution

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2
Q

Tranexamic acid indications

A

Epistaxis
Menorrhagia
Hereditary angioedema
General fibrinolysis
Thrombolytic overdose

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3
Q

Trenaxemic acid dose for menorrhagia

A

1g TDS for upto four days, max 4g a day
Begin when menstruation starts

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4
Q

Tranexamic adult dose for fibronlysis

A

1-1.5g two to three times a day

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5
Q

Tranexamic dose for epistaxis

A

1g TDS for 7 days

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6
Q

Tranexamic acid SE

A

Diarrhoea
Nausea
Vomiting

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7
Q

A patient is on Tranexamic acid and is suffering from diarrhoea, how do u manage this

A

Reduce dose

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8
Q

What do you monitor when using Tranexamic acid for long term hereditary angioedema?

A

LFTs

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9
Q

Whats the age restriction for Tranexamic acid OTC

A

18 years and older

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10
Q

Tranexamic acid cautionary and advisory labels

A

Take with or without food

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11
Q

A patient on the contraceptive pill and Tranexamic acid, what are they at high risk of?

A

Increased risk of DVT

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12
Q

Tranexamic acid red flags
How do you respond

A

Colour vision change or vision impairment -Stop medication immediately

Coughing, coughing up blood - refer

Anaphylactic reaction -refer

DVT/PE signs - refer

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13
Q

A patient is on Tranexamic acid and suffers from swollen, painful arms and legs, warm to touch, SOB and sharp pain in the chest.

What is this

A

DVT/PE

Refer to GP

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14
Q

Tranexamic acid CI

A

Pregnancy
DVT/PE
epilepsy
Irregular periods
Renal impairment
Patients on contraceptive pill -increased risk of thrombosis

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15
Q

Can tranexamic acid be used in pregnancy

A

Avoid as it crosses the placenta
Only use if benefit outweighs the risk - no evidence of teratogenicity

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16
Q

Is Tranexamic acid present in milk (breastfeeding)

A

Small amount present but antifibrinolytic affect unlikely

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17
Q

Can you give Tranexamic acid in renal impairment

A

Reduce dose

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18
Q

Venous thromboembolism has two types which are…..

A

Pulmonary embolism
Deep vein thrombosis

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19
Q

Whats the difference between DVT and PE?

A

PE is a clot in the lungs
DVT is a clot in the legs

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20
Q

All patients admitted to hospital need to be assessed for …..

A

Risk of bleeding and VTE

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21
Q

What classes of drugs are used in VTE. Give examples

A

Anti platelets - aspirin, clopidogrel, tricagrelor, dyprimadole

Anticoagulants- rivaroxaban, edoxaban, apixaban, dabigatran

Thrombolytics- alteplase- strongest!

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22
Q

Which class of drugs is associated with the highest bleeding risk

A

Thrombolytics - alteplase

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23
Q

Patients at high risk of VTE include

A

Those on COC or HRT
Overweight / obesity
Dehydrated
Limited mobility
Pregnancy
History of VTE
Thrombolytic disorder
malignant diseases - cancer
60yrs or over

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24
Q

Overweight vs obese BMI

A

Obese >30
Overweight 25-30

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25
Q

Who do you offer mechanical prophylaxis to?
How long should they wear it for?

A

Offer antiembolism stockings to those due to have surgery, they should wear it day and night until they are mobile again

26
Q

Who do you NOT offer mechanical prophylaxis to (anti-embolism stockings)

A

Peripheral arterial disease
Severe leg Oedema
Peripheral neuropathy
Leg conditions e.g., gangrene, dermatitis

27
Q

When do you offer pharmacological prophylaxis to those due for orthopaedic or general surgery?

A

When VTE risks outweighs bleeding risk

28
Q

In those admitted to hospital with VTE risk or those undergoing surgery offer…….

When?

A

Pharmacological prophylaxis
As soon as possible or within 14 hours of admission

29
Q

What VTE prophylaxis medication is suitable for ALL general and orthopaedic surgeries?

When is this medication CI and what do you give instead?

A

LMWH such as deltaparin, tinzaparin, enoxaparin

If theyre at high risk of bleeds or have renal impairment give unfractionated heparin

30
Q

When do you offer fondaparinux sodium?

A

In patients undergoing hip or knee replacement, hip fracture, GI bariatric or day surgery

31
Q

After the surgery how long should pharmacological prophylaxis be used for?

A

7 days after the surgery or until the patient is fully mobile

32
Q

What pharmacological prophylaxis is suitable for all orthopaedic and general surgeries

A

LMWH - tinzaparin, enoxaparin, deltaparin

33
Q

What pharmacological prophylaxis is given to those with renal impairment (crcl 15-60) or increased bleeding risk

A

Unfractionated heparin (heparin)

34
Q

What pharmacological prophylaxis do you give those who are undergoing abdominal, thoracic, cardiac, bariatric surgery or hip/knee replacement or have pelvic, hip or proximal femur

A

Fondaparinux sodium

35
Q

What pharmacological prophylaxis do you give to those with elective hip/knee replacement after LMWH or low dose aspirin

A

DOACs

36
Q

When do you give DOACs as a pharmacological VTE prophylaxis

A

Elective hip/knee replacement after low dose aspirin or LMWH

37
Q

Whats the first line treatment for confirmed DVT or PE

A

Rivaroxaban or apixaban

38
Q

Whats the 2nd line treatment for confirmed DVT or PE

A

LMWH for at least 5 days followed by edoxaban or dabigatran

39
Q

A patient is renally impaired (crcl 15-50ml/min) what options do you have for treatment of confirmed DVT or PE

A

Rivaroxaban or apixaban
Or LMWH for at least 5 days followed by dabigatran or edoxoban

40
Q

A patient is renally impaired (crcl <15ml/min) what options do you have for confirmed DVT or PE

A

LMWH or unfractionated

DONT GIVE DOACS

41
Q

A patient has confirmed DVT or PE and is pregnant what is the 1st line

A

Heparins! They dont cross the placenta
LMWH or unfractionated

42
Q

Why is dose alteration of LMWH required in pregnancy

A

Because it is eliminated quicker

43
Q

Why is LMWH preferred over heparin (unfractionated)

A

Because its associated with a lower risk of osteoporosis and heparin induced thrombocytopenia - low platelets

44
Q

Whats the duration of anticoagulant treatment in confirmed proximal DVT or PE

A

At least 3 months

45
Q

A patient suffers from active cancer and has confirmed DVT/PE, what would his anticoagulant treatment duration be?

A

3-6 months

46
Q

A patient has confirmed DVT/PE provoked by COC, what is his anticoagulant duration?

A

At least 3 months

47
Q

A cancer patient has confirmed DVT/PE due to pregnancy , what is his anticoagulant duration?

A

3-6 months

48
Q

A patient has confirmed DVT/PE, its unprovoked. Whats his duration of anticoagulant treatment?

A

> 3 months

49
Q

A cancer patient has confirmed DVT/PE, its unprovoked. Whats his duration of anticoagulant treatment?

A

> 6 months

50
Q

Whats proximal DVT and isolated DVT

A

Proximal DVT located in fermoral thigh, iliac abdomen veins

Isolated DVT is below knee and confined to calf veins

51
Q

For secondary prevention of confirmed DVT /PE or long term treatment, offer the initial anticoagulant if they tolerate it or if the current treatment is a DOAC switch to ….

A

Apixaban

52
Q

If a patient requires continued long term anticoagulant treatment for DVT/ PE and declines it offer …..

A

Aspirin

53
Q

Anticoagulants most common SE is

A

Bleeding

54
Q

If a patient on an anticoagulant bleeds what do you do

A

Stop the anticoagulant (LMWH, DOAC) but if the bleeding doesnt stop give antidote

55
Q

Whats the antidote for heparin

A

Protamine sulphate

56
Q

Does protamine sulphate reverse LMWH

A

Only partially

57
Q

Antidote for warfarin is

A

Vitamin K

58
Q

Why should LMWH be avoided in renal impairment

A

Because they increase risk of bleeds

59
Q

Phytomenadione is also known as

A

Vitamin K1

60
Q

Phenindione is

A

An oral anticoagulant like warfarin (coumarin)

Cardiovascular (9 decks)

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