CVS - Blood Clot/ Anticoagulants Flashcards
Which is more problematic if a dose is missed - DOAC or Warfarin? and why?
DOAC
because it has a shorter half life, which means there will be have greater loss of anticoagulation than warfarin.
What to do if you miss a WARFARIN dose
Take the missed dose as soon as you remember. If you do not remember until the next day, skip the missed dose and take your next dose at the usual time.
What to do if you miss DABIGATRAN dose
Take dose as soon as you remember
If a dose is more than 6 hours late, the missed dose should NOT be taken and the next dose should be taken at the normal time.
What to do if you miss a RIVAROXABAN dose
Take next dose as soon as you remember if you dont remeber til the next day skip dose
** if its treating DVT or PE: 15mg BD…
Do not take more than two 15mg tabs in a single day
(but can take 2x15mg at the same time to make a total of 30mg on one day e.g. if you miss morning dose and remember evening dose take two).
Continue with 15mg twice daily the following day
What to do if missed APIXABAN dose
Take the missed dose as soon as you remember.
If you do not remember until
- the next day
- MORE THAN 12 HRS (Once Daily Dose)
- or MORE THAN 6HRS (Twice Daily dose),
Skip the missed dose and take your next dose at the usual time.
What to do if missed EDOXABAN dose
Take the missed dose as soon as you remember.
If you do not remember until
- the next day
- MORE THAN 12 HRS,
Skip the missed dose and take your next dose at the usual time.
What is are the DOACs onset of action timing
1 - 4 hrs
Dabigatran 0.5-2hrs
Edoxaban 1-2hrs
Apixaban &
Rivaroxaban 2-4hrs
**roughly
What if WARFARIN onset of action
3-5 days
What is Heparin Induced Thrombocytopenia?
How long does it take to occur?
Which Heparin is more likely to cause it?
How to manage it?
Developing a low platelet count (reduction of at least 30%)
Can occur 5-10 days after commencing Heparin
Unfractionated Heparin more likely to cause it
Use of Haparinoid e.g. Danaparoids
Which DOAC causes the most GI side effects
Rivaroxaban
- GI Discomfort
- Constipation
- Diarrhoea
- Nausea
- Vomiting
What BASE LINE test need to be done before commencing DOACs (5)
FBC
Renal (adjust dose accordingly)
LFT
*Prothrombin Time (PT)
* Activated partial Thromboplastin Time (APTT).
Which DOAC is least likely to be chosen in renal impairment?
Dabigatran
Caution starts from CrCl being or less than 30
What is the antidote for too much warfarin (INR to high)
phytomenadione (vitamin K1)
What is the antidote of Dabigatran
IDARUCIZUMAB
What is the antidote for Apixaban and Rivaroxaban
ANDEXANET ALFA
What Heparin should be used in renal failure
Unfractionated Heparin
(still may require a dose reduction)
What VTE treatment is used in pregnancy?
and Why (3)
LMWH - Low Molecular Weight Heparin
because…
- It doesn’t cross the placenta
- Lower risk of HIT
- Lower risk of Osteoperosis
(BNF does state it is an unlicensed & the manufacturer suggest avoiding it due to vials containing Benzyl Alcohol)
What LMWH is suitable in breast feeding
Enoxaparin
What do you monitor when using Heparins (5)
Weight - dose depends on it
Platelets - risk of HIT
Potassium - risk of hyperkalemia
Renal - especially with LMWH
LFT
What is the antidote for Heparins
Protamine Sulphate
Fully reverses - UNFRACTIONATED
Partially reverses - LMWH
Which DOAC has a Loading and Maintenance dose
Apixaban
Which DOACs has Twice Daily dosing for DVT and PE prophylaxis?
&
Which DOACs has ONCE daily dosing for DVT and PE prophylaxis?
Twice Daily = Apixaban (5mg BD) and Dabigatran (150mg BD)
Once Daily = Rivaroxaban (20mg OD) and Edoxaban (30-60mg OD)
Which DOACs has Twice Daily dosing for DVT and PE treatment?
AND
Which DOACs has ONCE daily dosing for DVT and PE treatment?
Twice daily = Apixaban (10mg BD) and Rivaroxaban (15mg BD 21/7 then 20mg OD) and Dabigatran (75, 110-150 BD dependent on age,
Once daily = edoxaban (30/60mg OD dependent on weight)
Which DOAC must be taken with food
Rivaroxaban - to increase absorption
