BLOOD CLOTS Flashcards
1
Q
What is VTE?
A
Venous thromboembolism is blood clots which form in deep veins and can travel to lungs.
2
Q
What are 3 symptoms of DVT/VTE?
A
Unilateral pain/ swelling
Warm/red skin
Vein distension
3
Q
What are 3 symptoms of pulmonary embolism?
A
Dyspnoea
Chest pain
Coughing blood
4
Q
What 7 factors can increase risk of VTE?
A
Immobility
Obesity - BMI>30
Malignancy
60+ years
1st deg relative
Pregnancy, post-partum
Oestrogen
5
Q
What are 5 risk factors which can increase bleeding risk?
A
Acute stroke
Anti-coagulants
Systolic HypERtension
Thrombocytopenia (low platelets)
Bleeding disorders: Acquired - Liver Failure
Inherited - haemophilia, Von Willebrands
6
Q
What is thrombocytopenia?
A
Low platelets
7
Q
What are 2 pharmacological treatments of VTE prophylaxis?
A
- DOAC
- Heparain
8
Q
What medication is used for thromboprophylaxis in renal insufficiency?
A
Unfractionated heparin
9
Q
What is an alternative to heparin?
A
Fondaparinux
-Option for pt undergoing abdominal, bariatric, thoracic or cardiac surgery, or for patients with lower limb immobilisation
10
Q
How many days should you take heparin after general surgery?
A
7 days
11
Q
How many days should you take heparin after having major cancer surgery in abdomen?
A
28 days
12
Q
How many days should you take heparin after having spinal surgery?
A
30 days
13
Q
What are 2 mechanical methods for thromboprophylaxis?
A
Pneumatic compression
Anti- embolism stockings
14
Q
When to NOT offer anti-embolism stockings?
A
NOT in acute stroke or leg conditions. e.g. PAD
15
Q
When to offer anti-embolism stockings?
A
worn day and night until the patient is sufficiently mobile
or
30 days after spinal injury/acute stroke
16
Q
What mechanical method is used to prevent VTE after knee replacement surgery?
A
Pneumatic compression
17
Q
What mechanical method is used to prevent VTE after Hip replacement surgery?
A
Anti-embolism stockings
18
Q
How many days to take Rivaroxaban after having Hip surgery for thromboprophylaxis?
A
for 35 days
19
Q
How many days to take Rivaroxaban after having knee surgery for thromboprophylaxis?
A
14 days
20
Q
How many days should you take LMWH after hip surgery for thrombophrophylaxis?
A
Take LMWH for 28 days with anti-embolism stockings
OR
Take LMWH for 10 days PLUS low dose aspirin 28 days.
21
Q
How many days should you take LMWH + aspirin after knee surgery for thromboprophylaxis? (2 opts)
A
Take LMWH for 14 days + use anti-embolism stockings
OR
Low dose aspirin for 14 days.
22
Q
What are 2 alternatives to taking low dose aspirin for thromboprophylaxis after knee surgery?
A
Use Apixaban or dabigatron
23
Q
What is treatment drug option and duration for venous thromboembolism for proximal DVT/PE?
A
Apixaban or rivaroxaban for at least 3 months
24
Q
How long should treatment be for venous thromboembolism for proximal DVT/PE?
A
At least 3 months (3-6 months if ACTIVE cancer)
25
How long should treatment be for venous thromboembolism for proximal DVT/PE if UNPROVOKED?
3 months PLUS (6 months plus if active cancer)
26
What are alternatives that can be used for proximal DVT/PE thromboembolism treatment aside from apixaban/ rivaroxaban?
LMWH for 5 days + Edoxaban
OR
LMWH/ unfractionated + VIT K antagonist (warfarin)for 5 days
27
What is used first line for thromboprophylaxis in pregnancy?
LMWH
if immobile too + add in pneumatic compression/stocking
28
What is used first line for VTE in pregnancy if high risk of haemorrhage?
IV unfractionated heparin- short half life
29
List 3 factor Xa inhibitors?
Apixaban
Edoxaban
Rivaroxaban
30
List 1 Thrombin inhbitor?
Dabigatran
31
List 3 LMWH?
Tinzaparin
enoxaparin
Dalteparin
32
What are heparins split into?
LMWH
Unfractionated Heparin
Fondaparinux (Synthetic heparin/same ish)
33
What is the process of blood clotting?
Fibrinogen is converted to fibrin by enzyme thrombin
34
What enzyme is responsible for converting fibrinogen to fibrin?
Thrombin
35
What are 3 common errors with anticoagulants?
1. Dose - wrong/missed dose
2. Drug interaction - giving NSAIDs too or duplication
3. Monitoring - inadequate/errors
36
What is MOA of heparin?
activates ANTITHROMBIN which inhibits clotting facts Xa and IIa (thrombin)
37
What is 2 advantage of using heparin?
Less risk of thrombocytopenia + osteoporosis.
Fast onset of action BUT short duration
38
What is unfractionated heparin good for?
When there is high risk of bleeding
Used in
Renal impairment
39
Why is heparin used in pregnancy?
Does NOT cross BBB - safer.
Less risk of osteoporosis + thrombocytopenia
40
What are 4 SE of Heparin?
1. Bleeding
2.HypERkalaemia
3. Heparin induced thrombocytopenia
4. osteoporosis
41
What 2 things to monitor when on heparin?
K+ levels if more than 7 days tx
Platelet count if more than 4 days tx
42
What are 3 clinical signs of heparin induced thrombocytopenia?
Less than 30% platelets
Skin allergy
Thrombosis
43
What is the antidote for heparin called?
Protamine - partially reverses
44
What are some drug classes that can cause hypERkalaemia when taken with heparin?
ACEi/ARB, spironolactone, NSAIDs, potassium supplement, trimethoprim
45
What 5 drug classes can cause bleeding when taken with heparin?
Other anticoagulants
Anti-platelets
NSAIDs
Venlafaxine
SSRI
46
What is MOA of warfarin?
Antagonist of vitamin K + prevents blood clotting.
47
What is duration of warfarin?
48-72 hrs
48
What is the Indication of warfarin?
VTE, AF
49
What is the dose of Warfarin?
3-9mg daily at SAME TIME.
50
What to do if missed dose of warfarin?
Only take dose if missed more than 1 day of dose + take it the day you missed it.
51
What are the 4 strengths of warfarin + colours?
O.5 mg = white
1mg = brown
3mg = blue
5 mg= pink
52
What is dose and duration of treatment of warfarin for isolated calf DVT?
3mg blue tablet for 6 weeks
53
What is dose and duration of treatment of warfarin for Provoked VTE?
5mg pink tab for 3 months
54
What is dose and duration of treatment of warfarin for Unprovoked VTE/AF?
1mg brown tab for 3+ months
55
What is provoked VTE?
Reason for risk of clot
e.g surgery, COC pill , pregnancy , leg cast
56
Can warfarin be used in pregnancy?
NO- teratogenic
57
What is monitoring req for warfarin?
Base-line prothrombin time but 1st dose should not be delayed whilst getting result.
Monitor daily until between 2-3, then twice weekly for 1-2 weeks.
Then weekly measurements until at least 2 INR measurements are within the therapeutic range.
Every 3 months measure INR, change in warfarin doses or clinical condition
58
What is target INR for VTE, AF, MI, cardioversion or artificial valves?
2.5
59
What is INR target for patient with recurrent VTE if ALREADY on anticoagulant and if INR >2?
3.5- longer to clot
60
What MRHA advice was released on warfarin in 2016?
Report of calciphylaxis
61
What is calciphylaxis?
Build up of calcium in blood vessels of fat, skin + tissue?
62
What is a risk factor of calciphylaxis?
End stage renal disease
63
What is treatment of calciphylaxis in warfarin?
Consider stopping warfarin if diagnosed.
64
What to counsel patient on if they develop calciphylaxis on warfarin?
Report PAINFUL SKIN RASH
65
What is a main SE of warfarin?
Bleeding
66
What to do if patient's INR is 5-8 and there is NO bleeding?
Withold 1 to 2 doses of warfarin
67
What to do if patient's INR is 5-8 and there is MINOR bleeding?
give IV phytomenadione (warfarin antidote)
Restart warfarin sodium when INR <5.0
68
What to do if patient's INR is over 8 and there is NO bleeding?
Give oral phytomenadione
repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0
69
What to do if patient's INR is over 8 and there is MINOR bleeding?
IV phytomenadione
repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0
70
What is phytomenadione?
Vitamin K
Antidote for warfarin
71
What is the normal INR range?
0.8 to 1.1
72
How long does is take for blood to normally clot in normal person?
11 to 13.5 secs
73
What are 3 counselling points to reduce/prevent bleeding instances in patient on warfarin?
1. look out for Nose bleeds > than 10 mins, cuts which don't stop bleeding. RED urine, Blood in vomit, tarry stool, severe headaches
2. Avoid contact sports , can bruise
3. Use soft toothbrush to avoid bleeding gums
74
What 'bleeding rules' red flags to look out for when on warfarin?
Nose bleeds > than 10 mins, cuts which don't stop bleeding. RED urine, Blood in vomit, tarry stool, severe THUNDERCLAP headaches
75
What 3 drink/ foods interact with Warfarin?
Alcohol
Cranberry juice
Green leafy vegs
76
Why does leafy green veg interact with warfarin?
contains vit K so antagonises Warfarin anticoagulant effect
77
What 4 OTC drugs can interact with Warfarin?
Vit E and Vit K supplements
NSAIDs
Miconazole
78
What counselling point should be done for warfarin patients?
patient alert card and yellow book
79
What to do when patient on warfarin is about to have an elective surgery?
STOP warfarin 5 days before + then restart immediately after surgery.
80
What to do when patient on warfarin is about to have an emergency surgery which cannot be delayed?
IV phytomenadione
+
Dried prothombin complex
81
What to do when patient on warfarin is about to have an surgery BUT is high risk of VTE?
1. Bridge with LMWH
2. STOP LMWH 24 hrs before surgery.
3.If surgery has high risk of bleeding, the LMWH should NOT be restarted until at least 48 hrs AFTER surgery.
82
What is the interaction between NSAID + warfarin?
increased Bleeding risk
83
What does the interaction between warfarin + pomegranate juice cause?
Pomegranate juice increases the INR in response to warfarin.
84
What drug classes increase the anti-coagulation effect?
Amiodarone,
Azole anti-fungals e.g. fluconazole
Macrolide Abx- Clarithromycin + erythromycin
Metronidazole
Quinolones
Cimetidine
Cranberry juice
85
What 'term' increases anticoagulant effect?
Enzyme inhibitors - prevent breakdown of active drug + increase conc.
86
What 'term' decreases anticoagulant effect?
Enzyme inducers
87
What enzyme inducers reduce anti-coagulant effect?
Carbamazepine
Phenobarbital (anti-epileptic drugs)
Rifampicin
St John's wort
88
What is the risk of bleeding with aspirin compared to clopidogrel + warfarin?
Less bleeding risk with aspirin + warfarin
89
What are the enzyme Inducers? - SCRAP GPS
Smoking
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulphonyureas -e.g. Gliclazide
90
What does alcohol and warfarin interact to cause?
(Heavy) Alcohol is an enzyme inducer- so it decreases warfarin effect.
Acute drinking- increase bleeding
91
What does cranberry juice and warfarin interact to cause?
cranberry juice is enzyme inhibitor = increases warfarin effect.
92
What does warfarin and OTC miconazole interact to cause? what to do?
Miconazole increases the anticoagulant effect of Warfarin
MHRA = says avoid unless INR can be monitored closely.
93
What are enzyme inhibitors? SICKFACES COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole + Fluoxetine
Alcohol + grapefruit juice
Chloramphenicol
Erythromycin
Sulphonamides
Ciprofloxacin
Omeprazole
Metronidazole
94
What to do when patient on warfarin is about to have an emergency surgery which can be delayed by 6 -12 hrs?
IV phytomenadione
95
What is MHRA advice (2017) around warfarin and Micoazole?
OTC oral miconazole gel is contra-indicated with warfarin
Report sign of serious bleeding.
96
What is MOA of DOAC?
Directly inhibits clotting factor Xa or IIa (thrombin).
97
What is indication of DOAC?
VTE
Non-valvular AF
98
What are DOACs an alternative to?
Warfarin alternative.
99
What are 3 reasons that DOACs are better than warfarin?
Fixed dose regimen
No monitoring
Less food interactions
100
What to do if you miss a dose of a DOAC and it is more than 6 hrs?
If a dose is more than 6 hours late, the missed dose should NOT be taken.
The NEXT dose should be taken at the normal time.
101
How long does DOAC last in body?
Lasts 12 -24 hours in body
102
What DOAC requires to be in a special container + has short 4 month expiry?
Dabigatran
103
What DOAC is taken after food and can be crushed?
Rivaroxaban (esp high doses 15mg and 20mg)
104
What is an antidote for dabigatran?
Idarucizumab
Used in life-threatening or uncontrolled bleeding, emergency surgery.
105
What is an antidote for apixaban and rivaroxaban?
Andexanet alfa
106
What is Andexanet alfa used for?
Antidote for apixaban and Rivaroxaban.
107
What is a big SE of DOACS?
Bleeding
108
What to monitor in DOACs?
Signs of bleeding and anaemia.
Renal profile in renal impairment.
109
What is a MHRA (2020) advise given for DOACs regarding bleeding risk?
Be aware of signs of bleeding.
Caution in Renal impairment- in case reduce dose + monitor.
Counsel pt, read PIL
110
What is MHRA (2023) advise given for DOACs regarding dose adjustments in patients with renal impairment?
Review patients regularly during treatment + calculate CrCL
111
For Dabigatron, what do do if patient has CrCL of 30?
Avoid if creatinine clearance less than 30 mL/minute.
112
What is an MHRA 2018 warning for patients with prosthetic heart valves and rivaroxaban?
NOT for thromboprophylaxis- can increase mortality , bleeding events.
113
Why should patients with prosthetic heart valves not take rivaroxaban?
increased risk mortality, bleeding events.
114
What are patients with anti-phospholipid syndromes more at risk of with DOAC?
Increased risk of recurrent thrombotic events
115
What condition do patients have in which they are recommended NOT take DOACs?
Anti-phospholipid syndrome
116
What is the risk with using 2 DOACs referred to by MHRA Oct 2013?
Significant bleeding risk with new oral anticoagulants- contra-indication
117
What is rivaroxaban brand?
Xarelto
118
What is rivaroxaban dose and duration for VTE prevention for hip replacement patients?
10mg OD for 35 days
119
What is rivaroxaban dose and duration for VTE prevention for knee replacement patients?
10 mg OD for 14 days
120
What is rivaroxaban dose recurrent VTE prevention?
10mg OD for 6 months +
consider 20mg daily if higher risk of clot.
121
What is rivaroxaban dose for VTE treatment?
15 mg BD for 21 days with food, then 20mg OD
122
What is rivaroxaban dose for stroke prevention in non-valvular AF?
20mg OD
123
What is rivaroxaban dose for prevention of an atherothrombotic event ?
2.5mg BD-
can be used with aspirin + clopidogrel.
124
What is treatment duration of rivaroxaban in preventing atherothrombotic event in acute coronary syndrome?
for 12 months. - 2.5mg BD
125
What is apixaban dose for VTE prevention after hip replacement?
2.5mg BD for 32-38 days, 12- 24 hrs after surgery
126
What is apixaban brand?
Eliquiz
127
What is apixaban dose for VTE prevention after knee replacement?
2.5 mg BD for 10-14 days , 12- 24 hours after surgery
128
What is apixaban dose for recurrent VTE?
2.5 mg BD
129
What is apixaban dose for VTE treatment?
10mg BD for 7 days -THEN 5mg BD as maintenance.
130
What is apixaban dose in stroke prevention in non-valvular AF?
5mg BD
REDUCE to 2.5 mg BD if patient over 80+, < 61kg, creatinine >133.
131
What are the requirements for apixaban dose reduction in stroke prevention?
Reduce dose to 2.5 mg BD
-serum-creatinine 133 micromol/litre
- age 80 years+
-body-weight 60 kg or less
132
What is edoxaban brand?
Lixiana
133
What is edoxaban dose for VTE and stroke prevention and treatment in non- valvular AF?
30mg OD
134
What is Rivaroxaban administration?
Manufacturer advises tablets may be crushed and mixed with water or apple puree just before administration.
135
What DOAC can be taken with food for absorption?
Rivaroxaban
136
What is edoxaban dose for VTE and stroke prevention and treatment in non- valvular AF if patient weighs 61kg and +?
60mg OD
137
What is dabigatran brand?
Pradaxa
138
What is Dabigatran VTE prevention dose after hip replacement?
220mg OD for 35 days
139
What is Dabigatran VTE prevention dose after knee replacement?
220mg OD for 14 days
140
What is Dabigatran VTE prevention dose in elderly patients over 75 years + on amiodarone or verapamil?
75 mg for 1 dose, then 150mg OD
141
What is dabigatran dose for VTE treatment and stroke prevention in non-valvular AF?
150mg BD
142
What is dabigatran dose for VTE treatment and stroke prevention in non-valvular AF in patients OVER 75 years, moderate RI and bleeding risk?
110-150mg BD
143
What is dabigatran dose for VTE treatment and stroke prevention in non-valvular AF in patients OVER 80+ and on verapamil?
110mg BD
144
What is the effect of possible interactions between DOACs and anticoagulants?
Increased bleeding
145
What 5 drug classes can interact with DOAC to increase bleeding?
Heparins
Warfarin
NSAID
SSRI
antidepressant
146
What 4 drug classes can increase anticoagulant effect? (TIP- inhibitors)
Amiodarone
Azole antifungals- e.g. ketaconazole
Ciclosporin
Erythromycin
147
What 3 drugs/classes can reduce anticoagulant effect? (Think inducers)
Carbamazepine + phenobarbital (anti-epileptic drugs)
Rifampicin
St johns wort
148
Why is LMWH better than unfractionated heparin?
Less risk of heparin-induced thrombocytopenia and just as effective.
149
What are the 5 names of parenteral anti-coagulants?
Fondaparinux
Heparinoid
Argatroban
Hirudin
Epoprostenol
150
What are 2 oral anticoagulant names?
Acenocoumarol
Phenindione
151
What are heparinoids?
Danaparoid sodium
Prophylaxis of DVT in patients undergoing general or orthopaedic surgery.
Has a role in patients who develop heparin-induced thrombocytopenia.
152
What is argatroban given with?
An oral anticoagulant can be given with argatroban monohydrate, but it should only be started once thrombocytopenia has substantially resolved.
153
What are Hirudins?
Bivalirudin, a hirudin analogue + is a thrombin inhibitor.
Licensed for unstable angina or non-ST-segment elevation myocardial infarction in patients planned for urgent or early intervention.
154
Why is epopreostenol given?
Inhibit platelet aggregation during renal dialysis when heparins are unsuitable or contra-indicated.
Also licensed for the treatment of primary pulmonary HTN resistant to other treatment, usually with oral anticoagulation; it should be initiated by specialists in pulmonary hypertension.
155
Why is epoprostenol IV?
Epoprostenol is a potent vasodilator.
It has a short half-life of approximately 3 minutes
Therefore it must be administered by continuous IV infusion.
156
What 3 situations to avoid vit K antagonists?
within 48 hours postpartum
haemorrhagic stroke; significant bleeding
157
What is acenocoumarol?
Coumarin derivative used as an anticoagulant.
Inhibit the reduction of vitamin K by vitamin K reductase.
158
What class of drugs was known to interact with Acenocoumarol (Vit K antagonists) in 2017 MHRA?
Direct-acting antivirals for Hep C-
Monitor INR
159
Why should vit K antagonists NOT be given in 1st trimester?
Warfarin, acenocoumarol, + phenindione cross the placenta with risk of congenital malformations, and placental, fetal haemorrage.
160
What is arterial thrombosis?
Blood clot in artery which blocks blood supply to heart and brain.
161
What are 2 types of arterial thrombosis?
1. Ischaemic - TIA
2. Haemorrhagic
162
What is TIA?
Transient ischaemic attacks - mini strokes that temporarily stop blood supply to brain.
163
What are 2 causes of Ischaemic thrombosis?
Atherosclerosis, Thromboembolism/AF
164
What are 3 causes of Haemorrhagic thrombosis?
High BP
Aneurysm
Arteriovenous malformation
165
What are the Symptoms of Stroke?
Facial weakness
Arm weakness
Speech problems
Time - call 999
166
What is a long-term treatment option for TIA + Ischaemic stroke?
1st line = Clopidogrel (monotherapy)
2nd line = aspirin (if above contra)
High intensity statin (48 hrs after stroke)
167
What is 1st line long-term treatment option for TIA+ Ischaemic stroke?
clopidogrel
+ high intensity statin
168
What anti platelet is unlicensed in TIA long term management?
clopidogrel
169
What is treatment option for haemorrhagic stroke?
Anti-hypertensive
170
Why does ischaemic stroke happen?
Build up of fatty deposits.
171
What 3 drug classes to avoid in haemorragic stroke?
Aspirin
Statin
Anti-coagulants
172
What is MOA of anti-platelets?
Reduces platelet aggegration + inhibits thrombus formation in arteries
173
What BP to aim for after intracranial haemorrhage?
Aim for a systolic BP target of 130-139 mmHg within 1 hour and sustained for at least 7 days, ensuring that the magnitude drop does not exceed 60 mmHg within 1 hour of starting treatment.
174
What is low dose aspirin?
75mg OD
175
What is administration for Dipyridamole?
30 to 60 mins before food
176
What is administration for MR Dipyridamole?
Take it after food
177
What is storage for MR dipyridamole caps?
Special container
178
What is expiry for MR dipyridamole caps?
Discard in 30 days.
179
What are 6 examples of glycoprotein IIb/IIIa inhbitors?
Cangrelor
Prasugrel
Ticagrelor
Abciximab
Eptifibatide
Tirofiban
180
What should patients do if they have acute stroke symptoms?
immediately hospital
181
What is 1st line tx for TIA/minor stroke initial management?
Immediate aspirin 300mg
if contra = PPI or another antiplatelet
182
What should patients presenting within 24 hrs of TIA/ minor stroke with low bleeding risk be on?
Dual Antiplatelet therapy
(clopidogrel/ticagrelor + aspirin)
183
What to do if dual antiplatelet therapy Contra-indicated in TIA initial management?
monotherapy clopidogrel.
184
What to give patients with dyspepsia on aspirin to reduce GI bleed?
PPI
185
What is ischaemic stroke initial management in acute + within 4.5 hrs of symptoms?
Alteplase or tenecteplase
186
When to administer TPa for stroke?
within 4.5 hrs of symptoms + intracranial haemorrhage excluded
187
What condition should be excluded when giving alteplase for ischaemic stroke?
intracranial haemorrhage
188
What should be started 24 hours after ischaemic stroke?
Antiplatelets
189
What are patients with disabling ischaemic stroke started on?
Aspirin within 24 hrs + continue 2 weeks after
190
How long is aspirin continued for in patients with disabling ischaemic stroke?
2 weeks then start long term
191
When should patients be started EARLIER long term anti-thrombotic treatment after stroke?
If being moved to care home before 2 weeks of aspirin
192
Is anticoagulant recommended as alternative to anti-platelet in ischaemic stroke + sinus rhythm?
NO only if stroke linked to AF.
193
When may anticoagulants be indicated for stroke?
DVT + PE with stroke
194
If patient has immobility with stroke , what should not be GIVEN?
LMWH
or
Graduated compression stockings
195
What anticoagulant should NOT be given in acute phase of ischaemic stroke?
Warfarin
196
Patients receiving anticoagulation for a prosthetic heart valve who experience a disabling ischaemic stroke + are at high risk of bleed should have their anticoagulant stropped for ---- days?
7 days + switch to aspirin
197
What can treatment of HTN in acute phase of stroke lead to?
Reduced cerebral perfusion
only treat HTN in emergency
198
When can statin be given in stroke patients?
As soon as they can swallow medication
Does not matter their cholesterol level
199
What drug should NOT be used for HTN management after stroke?
Beta blocker
200
What method is required after intracerebral haemorrhage to remove the haematoma?
Surgery
201
When should rapid BP lowering meds not be given to patients in Intracerebral haemorrhage? (4 reasons)
underlying structural cause
score <6 on glasgow coma scale
early neurosurgery
large Haematoma - poor diagnosis
202
When to consider rapid BP meds after Intracerebral haemorrhage?
symptoms present within 6 hrs
BP 150 -220 mmhg
203
What is target BP post haemorrhage?
130-139 mmhg within 1 hrs
maintain for 7 days
204
What to do about BP control if patient present after 6 hours of symptom onset?
case by case basis
205
Can patients be in anticoagulants after intracranial haemorrhage?
NO stop it- reverse it.
206
What to give patient using anticoagulant for DVT but also has intracranial haemorrhage
Caval filter
207
What cholesterol drug is avoided following intracerebral haemorrhage?
Statins
208
1st line tx for blocked catheter lines?
Urokinase
209
What are 5 risk factors of VTE if on COC?
40 years and older—if 50 years and older, seek specialist advice before use of contraceptives;
6 weeks -6 months postpartum in breastfeeding women.
3 to 6 weeks postpartum in non-breastfeeding women.
Smoking if age <35 years, or if 35 years + older + have stopped smoking at least 1 year ago.
body mass index 30 kg/m2 to 34 kg/m2
History of HTN during pregnancy
Family HX
Major surgery
210
What crCL to stop apix, rivaroxaban and edoxaban?
less than 15ml/min
211
What dose edoxaban if crcl 15-50?
Use a dose of 30 mg once daily if creatinine clearance 15–50 mL/minute
212
What dose adjustment of edoxaban if taking with dronedarone, erythromycin, ciclosporin or ketoconazole? (DECK)
30MG OD
213
What is edoxaban dose if patient weights less than 61kg?
30 mg OD
214
Indication of Tranexamic acid?
Menorrhagia and local fibrinolysis
215
Dose of Tranexamic acid for heavy periods?
1g TDS for 4 days
P med licensed for 18+ with regular menstrual cycle
216
MOA of tranexamic acid?
Prevents bleeding
increased risk of VTE with contraceptives
217
6 contraindications of tranexamic acid?
epilepsy, DVT, PE, irregular periods, renal problems, pregnancy
218
3 SEs of tranexamic acid?
Colour vision change or visual impairment (discontinue), signs of DVT and thromboembolism.
219
When to reduce dose of tranexamic acid?
if diarrhoea
220
What 4 drugs does edoxaban interact with + need dose reduction? DECK
ciclosporin, dronedarone, erythromycin, or ketoconazole
221
What is Fluconazole and warfarin interaction plan to prevent?
fluconazole - adjust the dose and monitor INR
222
What INR is oral phytomeniadone given before surgery?
should be given the day before surgery if the INR is ≥1.5.
