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BNF > CHAPTER 2: CVS: Thromboembolism > Flashcards

CHAPTER 2: CVS: Thromboembolism Flashcards

1
Q

What must the risk of clotting be weighed up against when deciding on thromboprophylaxis?

A

Bleeding

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2
Q

What are the options for pharmacological prophylaxis in patients undergoing general or orthopeadic surgery?

A
  1. LMWH

2. Heparin

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3
Q

Which is the pharmacological thromboprophylaxis of choice in patients with renal impairment?

A

Heparin

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4
Q

Which is the pharmacological thromboprophylaxis is an option for patients undergoing hip or knee replacements, hip fracture surgery or day surgery?

A

Fondaparinux

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5
Q

Which NOACs are indicated for thromboprophylaxis following hip or knee surgery? (3)

A
  1. Rivaroxaban
  2. Apixaban
  3. Dabigatran
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6
Q

How long should pharmacological thromboprophylaxis be continued for following surgery? (2)

A
  1. 5-7 days

2. Until patient is mobile

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7
Q

After which surgery should pharmacological thromboprophylaxis be extended to 28 days?

A

Major cancer surgery in the abdomen or pelvis

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8
Q

What is the choice in pharmacological thromboprophylaxis for general medicine patients?

A
  1. LMWH
  2. Heparin
  3. Fondaparinux
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9
Q

If pharmacological thromboprophylaxis is contra-indicated, what can be offered?

A

Mechanical thromboprophylaxis

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10
Q

What is initially used in the treatment of VTE?

A

LMWH SC injection

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11
Q

What is an alternative to LMWH in the treatment of VTE? (2)

A
  1. Heparin infusion

2. Intermittent heparin SC injection

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12
Q

When is the oral anticoagulant started in the treatment of VTE?

A

At the same time as the LMWH/Heparin

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13
Q

How long can a patient be taking both the LMWH/Heparin and oral anticoagulant in the treatment of VTE?

A

At least 5 days until INR is >2

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14
Q

What is the treatment of choice for VTE in pregnancy and why?

A

Heparins - do not cross the placenta

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15
Q

Why are LMWH preferred in VTE pregnancy? (2)

A
  1. Lower risk osteoporosis

2. Lower risk thrombocytopenia

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16
Q

What is the antidote for heparin? (only partially works in LMWH)

A

Protamine sulfate

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17
Q

What is the treatment for TIA?

A

Aspirin or clopidogrel if intolerant

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18
Q

What is recommended for the treatment of acute ischaemic stroke?

A

Alteplase

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19
Q

How soon after the onset of symptoms should alteplase be administered?

A

4.5 hours

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20
Q

How long after thrombolysis with alteplase should aspirin 300mg be administered and for how long?

A

24 hours

2 weeks

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21
Q

After which type of stroke should anticoagulants be used?

A

Cardio-embolic

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22
Q

What do you do if a patient already receiving anticoagulation for a heart valve has a stroke?

A

Stop their anticoagulant for 7 days while giving aspirin

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23
Q

Following the acute treatment of stroke, what is the recommended long term treatment?

A

Clopidogrel

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24
Q

If clopidogrel is not tolerated or contra-indicated, what is an alternative for long-term treatment after stroke?

A

Dipyridamole MR + Aspirin

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25
Q

What should patients who had a stroke due to AF be given as long-term treatment?

A

Anticoagulants

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26
Q

How long after symptom onset of stroke should a statin be started?

A

48 hours

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27
Q

Following a stroke, what is the blood pressure aim

A

< 130/80 mmHg

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28
Q

Which drugs should not be used for hypertension after stroke?

A

Beta blockers unless if being used for a different indication

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29
Q

What is the acute and long-term treatment of cerebral hamorrhage?

A

NOTHING

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30
Q

In which side of the circulation do anticoagulants exert their effect?

A

Slower moving, venous side

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31
Q

Which is the vitamin K antagonist used for anticoagulation?

A

Warfarin

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32
Q

An INR which is in x of the target value is generally accepted

33
Q

What is the target INR for: treatment of DVT or PE?

34
Q

What is the target INR for: AF?

35
Q

What is the target INR for: bioprosthetic heart valves?

36
Q

How long must patients with bioprosthetic heart valves be anticoagulated?

37
Q

What is the target INR for mechnical valves?

A

varies according to the make, location and patient factors

38
Q

What is the target INR for recurrent DVTs?

39
Q

How long should isolated deep calf thrombosis be treated with warfarin for?

40
Q

How long should DVT provoked by surgery or other transinet risk factor be treated with warfarin for?

41
Q

How long should unprovoked DVT be treated with warfarin for?

A

at least 3 months

42
Q

What is the main adverse effect of all oral anticoagulants?

43
Q

If a patient experiences major bleeding with an INR >8, what should they be given?

A

IV Vitamin K

44
Q

If a patient experiences minor bleeding with an INR >8, what should they be given?

A

IV Vitamin K

45
Q

If a patient experiences no bleeding with an INR >8, what should they be given?

A

Oral vitamin K (injection orally)

46
Q

If a patient experiences minor bleeding with an INR 5-8, what should they be given?

A

IV Vitamin K

47
Q

If a patient experiences no bleeding with an INR 5-8, what should they be given?

A

Nothing, withhold 1 or 2 doses of their warfarin

48
Q

How long before elective surgery must warfarin be stopped?

49
Q

What must be given by mouth in patients taking warfarin if the day before, INR is >1.5?

A

Oral vitamin K

50
Q

When can warfarin be resumed after surgery?

A

On the evening after

51
Q

Which patients may require warfarin “bridging” with a LMWH at treatment dose?

A

High risk of thromboembolism

52
Q

What would put someone at high risk of thromboembolism? (3)

A
  1. History of thromboembolism within the last 3 months
  2. Mechanical heart valve
  3. Previous stroke
53
Q

How long before surgery should a LMWH be stopped?

54
Q

If a patient on warfarin requires emergency surgery that can be delayed for 6-12 hours, what can be administered?

A

IV Vitamin K

55
Q

If a patient on warfarin requires emergency surgery that cannot be delayed what can be administered? (2)

A
  1. IV Vitamin K
  2. Dried prothombin complex
    - INR checked before surgery
56
Q

Which has a longer duration of action heparin or LMWH?

57
Q

Why are LMWH preferred in the treatment and prevention of VTE? (2)

A
  1. Lower risk of heparin induced thrombocytopenia

2. Once daily administration as longer duration of action

58
Q

What is the antidote for dabigatran?

A

Idarucizumab

59
Q

In which circulation do antiplatelets work?

60
Q

Is there a benefit in using aspirin as primary prophylaxis?

61
Q

If a patient is at high risk of bleeding what can be added with aspirin treatment?

62
Q

How long is dual antiplatelet therapy after an MI? (ACSAB)

A

Clopidogrel and aspirin for 1 year then clopidogrel is discontinued and aspirin is given lifelong

63
Q

If clopidogrel and aspirin combination cannot be used due to contra-indication to aspirin, what is the option?

A

Just clopidogrel

64
Q

Other than clopidogrel, which other drugs can be used in combination with aspirin? (2)

A
  1. Prasugrel

2. Ticagrelor

65
Q

After elective insertion of a bare-metal stent, aspirin is given lifelong. Clopidogrel is also given for how long?

A

1 month
12 months if due to ACS
12 months if drug eluting

66
Q

Unless specifically indicated (Kawasaki disease), who should aspirin not be given to?

A

Children under 16 - risk of Reyes

67
Q

What is the maximum pack size of aspirin caps/tabs OTC?

68
Q

What is the maximun amount of aspirin caps/tabs that can be sold OTC?

69
Q

How long before elective surgery must clopidogrel be discontinued?

70
Q

Apixaban should be avoided in patients with major risk factors for bleeding. Give 2 examples

A
  1. Known or suspected oesophageal varices

2. Recent or current gastric ulcers

71
Q

When should apixaban be dose reduced from 5mg BD to 2.5mg BD? (3)

A
  1. eGFR <30
  2. Weight <60
  3. Age >80
72
Q

What is the rivaroxaban dose for VTE treatment?

A

15mg BD for 3 weeks then 20mg OD thereafter

73
Q

How long after heparin administration does clinically important thrombocytopeania occur?

74
Q

What are signs of heparin-induced thrombocytopeania? (3)

A
  1. Platelet reduction of 30%
  2. Thrombosis
  3. Skin allergy
75
Q

What should be done if heparin-induced thrombocytopeania occurs?

A
  1. Stop the heparin

2. Replace it with danaparoid

76
Q

Why does heparin cause hypekaleamia?

A

Inhibition of aldosterone

77
Q

What must be monitored in patients taking heparin?

A
  1. Platelets

2. Potassium

78
Q

What is the MHRA warning concerning warfarin?

A

Interaction with hepatitis medicines changing the INR

79
Q

Why should patient taking warfarin inform their doctor if they develop a rash?

A

MHRA warning, risk of calciphylaxis with warfarin

BNF (28 decks)

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