Clotting

Question 1

Define stasis

Answer 1

Reduction in blood flow

Question 2

Which anticoagulant does not need a dose adjustment in renal impairment?

Answer 2

Heparin. (LMWHs do need to though)

Question 3

Bad side effect of heparin to be aware of?

Answer 3

HITS. Heparin induced thrombocytopenia syndrome - extreme drop in platelet count

Question 4

Name 2 Factor Xa inhibitors

Answer 4

Rivaroxaban and apixaban

Question 5

What monitoring do Rivaroxaban and apixaban require?

Answer 5

None

Question 6

Common side effects of Rivaroxaban?

Answer 6

Bleeding, peripheral oedema, itch.

Rare = hepatotoxicity

Question 7

Common side effects of apixaban?

Answer 7

Nausea, bleeding,

Less common= LFT changes, allergic reaction

Question 8

Main difference in Rivaroxaban and apixaban dosing?

Answer 8

Rivaroxaban = once daily. Apixaban = twice daily

Question 9

Method to follow when switching from DOAC to warfarin?

Answer 9

Keep taking the DOAC with warfarin until the INR is above 2 for 2 consecutive days

Question 10

Dabigatran ADRs?

Answer 10

Bleeding, GI bleeding, indigestion, ulcers

Question 11

Initiation of dabigatran?

Answer 11

Need to use heparin or enoxaparin for 5 days, then start dabigatran

Question 12

Warfarin prevents the production of which clotting factors?

Answer 12

The vitamin K dependent ones.

2, 7, 9 and 10

Question 13

Why are heparin and warfarin often started at same time?

Answer 13

Heparin onset of action is much faster, so heparin is started with warfarin until warfarin levels are high enough (takes a few days due to long half life of factor 2)

Question 14

Heparin MOA?

Answer 14

Binds to antithrombin and inactivates factor 2a (thrombin) and Xa

Question 15

Enoxaparin MOA?

Answer 15

Binds to antithrombin and inactivates 2a (thrombin) and Xa

Question 16

Role of factor Xa?

Answer 16

Converts prothrombin into thrombin.

Thrombin then turns fibrinogen into fibrin

Question 17

Factor Xa inhibitors?

Answer 17

Heparin, enoxaparin, Rivaroxaban, apixaban

Question 18

Signs of excessive bleeding?

Answer 18

Nose bleed, bruising, pink / red urine, red or black in faeces, rash

Question 19

Side effect to be aware of in with warfarin?

Answer 19

Skin necrosis and bleeding

Question 20

Non-drug VTE prophylaxis options?

Answer 20

Graduated compression stockings, foot pump, etc

Question 21

Aspirin in VTE prophylaxis?

Answer 21

Not recommended because anticoagulants are much more effective.

Question 22

VTE prevention in long distance travel?

Answer 22

No evidence that aspirin is effective.
If at high risk, could use a DOAC or enoxaparin.
Better of with GCS or moving around