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Pre reg > cardiovascular- anticoagulation > Flashcards

cardiovascular- anticoagulation Flashcards

1
Q

What is tranexamic acid used for and how does it work?

A

Prevents bleeding by inhibiting fibrinolysis

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2
Q

Why should patients on oral contraception use tranexamic acid in caution?

A

Risk of thrombosis

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3
Q

What is prothrombin complex used for and who is it contraindicated in?

A

Haemorrhage. patients with history of heparin induced thromboctopenia

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4
Q

What do you use to prevent ischaemic neurological defects following a subarachnoid haemorrhage?

A

nimodipine

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5
Q

What are the risks for VTE?

A

reduced mobility, obesity, malignant disease, history of VTE, thrombophilic disorders, over 60 years

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6
Q

What are the risks for bleeding?

A

acute stroke, thrombocytopenia, inherited bleeding disorders

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7
Q

What VTE prophylaxis is preferred in renal failure?

A

unfractionated heparin

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8
Q

What surgical patients can have fondaparinux?

A

hip/knee replacement, GI bariatric, day surgery

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9
Q

What surgery types can have DOACs after?

A

hip or knee replacement

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10
Q

How long should pharmacological prophylaxis continue post surgery?

A

5-7 days or until mobile

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11
Q

What surgery should have pharmacological prophylaxis extended to 28 days?

A

major cancer surgery in the abdomen or pelvis

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12
Q

How do you treat VTE?

A

Initially a LMWH/unfractionated heparin at the same time an oral anticoagulant. Continue heparin for at least 5 days and until the INR is >=2 for at least 24 hours.

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13
Q

How do you monitor heparin?

A

APTT

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14
Q

How do you manage VTE in pregnancy?

A

Heparins do not cross the placenta. LMWH are eliminated more rapidly in pregancy (BD dosing)

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15
Q

What reverses heparin?

A

Protamine

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16
Q

How do you initially manage a TIA?

A

immediately receive aspirin (if not tolerated give clopidogrel)

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17
Q

When should alteplase be administered?

A

within 4.5 hours of symptom onset of acute ischaemic stroke

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18
Q

When should aspirin be given in stroke management?

A

24 hours post thrombolysis. Within 48 hours of symptom onset in patients not receiving thrombolysis

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19
Q

Why shouldn’t you treat hypertension in the acute phase of ischaemic stroke?

A

Can reduce cerebral perfusion

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20
Q

What is the long term management following a TIA?

A

MR dipyridamole with aspirin. Intolerant to aspirin then just MR dipyridamole or aspirin if vice versa. Last option is clopidogrel

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21
Q

What is the long term management following an ischaemic stroke?

A

clopidogrel long term.
If contraindicated give MR dipyridamole in combo with aspirin.
If have AF then anticoagulate
Start statin 48 hours after stroke
Blood pressure following acute phase target <130/80- don’t start on beta blocker

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22
Q

Name 3 vitamin K antagonists?

A

warfarin, acenocoumarol, phenindione

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23
Q

How long does warfarin take to work?

A

48 to 72 hours

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24
Q

What is the target INR for treatment of DVT/PE and AF?

A

2.5

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25
Q

What is the target INR for the recurrent DVT/PE and also mechanical heart valve?

A

3.5

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26
Q

How long should you anticoagulate someone with an isolated calf DVT?

A

6 weeks

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27
Q

How long should you anticogulate someone with a VTE provoked by transient risk factors?

A

at least 3 months

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28
Q

How do you control major bleeding?

A

stop warfarin, IV phytomenadione (vitamin K), dried prothrombin complex

29
Q

How do you control minor bleeding with INR>8?

A

stop warfarin, IV phytomenadione (vitamin K), can repeat vit K if INR still high after 24 hours. Restart warfarin when INR<5

30
Q

What do you do if INR>8 and no bleeding?

A

stop warfarin, give vitamin K orally using the IV preparation, can repeat vitamin K if INR still high after 24 hours

31
Q

How do you control minor bleeding with INR 5-8?

A

stop warfarin, give vitamin K IV

32
Q

What do you do if INR 5-8 with no bleeding?

A

hold 1 or 2 warfarin doses and reduce subsequent maintenance doses

33
Q

How do you control warfarin before surgery?

A

stop 5 days before before elective surgery. Give Vit K the day before if INR >=1.5.
If at high risk (VTE in last 3 months, AF with previous stroke/TIA, or mechanical heart valve) bridge with LMWH treatment dose.

34
Q

How do antiplatelet drugs work?

A

Decrease platelet aggregation and inhibit thrombus formulation in arterial circulation (mainly platelets)

35
Q

What do you need to control before you give aspirin?

A

Unduly high BP

36
Q

Heparin

A

initiates anticoagulation rapidly. Has a short duration of action

37
Q

Why are LMWH preferred?

A

Lower risk of heparin induced thrombocytopenia, does not require monitoring, duration of action longer

38
Q

Name a Heparinoid and what it is used for?

A

Danaporoid. Used for prophylaxis of DVT in patients undergoing surgery. Role in HIT

39
Q

What are the different doses of aspirin?

A

Secondary prevention: 75mg OD
NSTEMI: initially 300mg then 75mg for 12 months
STEMI: initially 300mg then 75mg for at least 4 weeks
acute ischaemic stroke: 300mg for 14 days

40
Q

What are the side effects of aspirin?

A

blood disorders, GI haemorrhage, increased bleeding time

41
Q

Who is aspirin contraindicated in?

A

peptic ulcers, under 16, haemophilia

42
Q

What are the different doses of clopidogrel?

A

Prevention in PCI: loading dose 300mg
NSTEMI with aspirin: 300mg then 75mg for up to 12 months
STEMI: 300mg then 75mg for at least 4 weeks

43
Q

Name some factor 10a inhibitors?

A

Apixiban, fondiparinux, rivaroxaban

44
Q

What are the different doses of apixiban?

A

VTE prophylaxis following TKR: 2.5mg BD for 10-14 days, starting 12-24 hours post surgery
VTE prophylaxis following THR: 2.5mg BD for 32-38 days, starting 12-24 hours post surgery
DVT/PE treatment: 10mg BD for 7 days, then 5mg BD
Prophylaxis of recurrent DVTs: 2.5mg BD following completion of 6 months
Prophylaxis in AF with 1 risk factor; under 80: 5mg BD, over 80: 2.5mg BD

45
Q

What are the risk factors to allow use of DOAC?

A

Previous stroke or TIA, HF, age over 75, diabetes, HTM

46
Q

What renal function should you avoid apixiban?

A

less than 15

47
Q

What is fondiparinux used for?

A

VTE prophylaxis, treatment of unstable angina/NSTEMI/STEMI, VTE treatment
CI in renal function less than 30

48
Q

What are the different doses of rivaroxaban?

A

VTE prophylaxis following TKR: 10mg OD for 2 weeks, starting 6-10 hours post surgery.
VTE prophylaxis following THR: 10mg OD for 5 weeks, starting 6-10 hours post surgery
DVT treatment: 15mg BD 3 weeks, then 20mg OD
Prophlyaxis in AF with 1 risk factor: 20mg OD
Prophylaxis in ACS: 2.5mg BD for 12 months

49
Q

When are heparins contraindicated?

A

acute bacterial endocarditis

50
Q

What is a side effect of heparins?

A

osteoprosis

51
Q

What is heparin induced thrombocytopenia, when does it develop and what are the signs of it?

A

immune mediated, develops after 5-10 days,

30% reduction in platelet count, thrombosis or skin allergy.

52
Q

Why do heparins cause hyperkalaemia?

A

inhibit aldosterone secretions

53
Q

What monitoring is required for heparins?

A

Platelets before and after 4 days

Potassium before and regularly after

54
Q

When should you be cautious with enoxaparin?

A

low body weight. Reduce dose if CrCl<30

55
Q

Name 3 direct thrombin (2a) inhibitors

A

Agatroban, Bivalirudin, Dabigatran

56
Q

What is the use of Agatroban?

A

anticoagulation in patients with type 2 HIT who require parenteral anticoagulation

57
Q

How do you monitor Agatroban?

A

APTT 2 hours after start of treatment, then 2-4 hours after infusion rate altered, then OD

58
Q

What renal function should you avoid rivaroxaban?

A

CrCl less than 15

59
Q

What are the different doses of dabigatran?

A
  • VTE prophylaxis TKR: <75yrs 110mg 1-4 hours post surgery, then 220mg OD for 9 days (12-24 hours after inital dose) >75yrs have 75mg and 150mg
  • VTE prophylaxis THR: 27-34 days
  • DVT treatment: <75 150mg BD following 5 days of parenteral treatment. 75-79 110-150mg BD, >80 110mg BD
  • AF: 110-150mg BD
60
Q

What happens to the dose of dabigatran if patient is on verapamil or amiodarone?

A

second dose is 150mg. take dose at the same time as verpamil or amiodarone

61
Q

What renal function should you avoid dabigatran?

A

less than 30

62
Q

How often do you have to monitor renal function with dabigatran?

A

before starting and annually

63
Q

Name a Tissue Plasminogen Acitvator

A

Urokinase (IV infusion)

64
Q

What food interactions are there with warfarin?

A

major changes in diet and alcohol can affect control

avoid cranberry juic

65
Q

can pregnant women have warfarin?

A

no- teratogen

66
Q

what are side effects of warfarin?

A

hepatic dysfunction, jaundice, pancreatitis

67
Q

What do you need monitor with warfarin?

A

baseline prothrombin time, INR daily/alternate days during early treatment, then longer intervals up to 12 weeks. Change in condition then increase monitoring

68
Q

When should you avoid warfarin?

A

severe hepatic impairment.

Caution mild to moderation renal impairment. Monitor INR

Pre reg (11 decks)

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