Cardiac Anticoagulant Flashcards
Preferred agent for reversing Xa inhibitors (apixaban rivaroxaban(
andexanet alfa
Agent to reverse dabigatran (direct thrombin (factor IIa) inhibitor)
idarucizumab (praxbind)
Cockroft formula
Ideal Body weight
Adjusted body weight
CHA2DS2-VASc
hasbled score
(3 or higher is considered an increased risk of bleeding)
Scoring for CHADS2-VASc
Reversing enoxaparin with protamine
1 mg of exoxaparin is equal to 100 antiXa units
1 mg of protamine will reverse 1 mg of enoxaparin
1 mg of protamine will reverse 100 units of heparin
if over 8 hours give 1/2 of the protamine dose (enoxaparin)
if over 2 hours give 1/2 of the protamine dose (heparin)
When do you transition from warfarin to apixaban?
wait until INR falls to less than 2
When should edoxaban not be used?
When CrCl is greater than 95 ml/minute
What are the 1st line treatment options for VTE
- rivaroxaban
- apixaban
- warfarin plus LMWH bridge
- edoxaban with LMWH predosing
- dabigatran with LMWH predosing
CHEST guidelines on VTE treatment
DOACS are recommended over vitamin K antagonist such as warfarin, for VTE treatment without an associated cancer diagnosis
If pt on warfarin and being started on amiodarone, the dose should be reduced by how much percent?
30 to 50 %
Triggers for vasoocclusive crisis in patients with sickle cell disease
infections, dehydration, stress, changes in weather
When is AC therapy recommended for patients with AF?
CHA2DS2VASc
score oft two or more in men
score of three or more in women
except those with moderate to severe mitral stenosis or a mechanical heart valve
Warfarin- DOC in end-stage renal chronic kidney disease
Dabigatran, rivaroxaban, apixaban, edoxaban are all preferred over warfarin for cardioembolic stroke prevention in patients indicated for AC therapy
Warfarin affects which vitamin K dependent clotting factors
2, 7, 9 and 10
warfarin reversal
4 factor PCC (Kcentra) 5000 units
(50 units/kg) not to exceed 5,000 units
also vitamin K 10 mg IV
(subcut has erratic and unpredictable absoprtion
apixaban and rivaroxaban reversal
Andexanet alfa
what is needed for Vitamin B 12 be absorbed?
Intrinsic factor
Approved VTE prophylaxis in knee replacement surgery
apixaban and rivaroxaban
Approved VTE prophylaxis in hip replacement surgery
apixaban, rivaroxaban, dabigatran
What interacts with iron?
fluroquinolones, levothyroxine and tetracyclines
What can increase the absorption or bioavailability of the elememental iron?
Vitamin C
Dosing for rivaroxaban for VTE
15 mg BID po BID for 21 days followed by 20 mg daily
Common medications with causing thrombocytopenia
chemo agents
heparin
linezolid
LMWH
quinine
ranitidine
ticlopidine
valproic acid
vancomycin
What class is apixaban?
Xa inhibitor (DOAC) BID dosing
What class is dabigatran
Direct Thrombin inhibitor
What class is prasugrel
P2Y12 antagonist (ADP inhibitor)
Types of macrocytic anemia
folic acid (B9) and cyannocobalamin (vitamin B12 )
what are fat soluble vitamins?
ADEK
Which has greater degree of platetelet inihibition?
prasugrel and ticagrelor more than clopidogrel
What are the DOACs
apixaban, edoxaban, rivaroxaban
FDA approved to chelate iron
deferasirox (exjade)
deferiprone (Ferriprox)
deferoxamine (desferal
What is NOT
dexrazoxane (Zinecard)
what is the half life of amiodarone?
60 days
When to hold apixaban?
For low risk procedures: dermatologic or dental procedures (root canal, multiple tooth extraction): hold one day prior and restart the next day
For high risk procedures: hold 2 days prior then restart 2 to 3 days after the procedure
what is the onset of action for 4 factor PCC
what about vitamin K or phytonadione
what about FFP?
10 minutes for 4 factor PCC
4 to 6 hours for IV and 18-24 hours for oral (vitamin K)
slower by 6.5 hours compared to 4PCC
When does Rh incompatibility occur?
When Rh negative Mom is exposed to Rh positive fetus, leading to the mother’s development of Rh antiboides
In immune mediated HIT what percentage reduction of platelets is usually seen?
30 to 50 percent
