Hematology

Question 1

Heparin MOA

Answer 1

catalyst - accelerates rate at which AT3 neutralizes thormbin and factor Xa - releases heparin once bound

Question 2

Heparin hold times

Answer 2

IV UFH = 4-6 hrs
Sq UFH = 12 hrs
cath placement ok if no other coagulopathy and placement proceeds hep admin by atleast 1 hr or 24 hrs for CV
-indwelling, remove 2-4 hrs after last dose

Question 3

Heparin restart

Answer 3

low risk = 24 hrs

48-72 hrs = high risk

Question 4

LMWH’s

Answer 4

daltaparin (fragmin)
enoxaparin (lovenox)
tinzaparin (innohep)

Question 5

LMWH’s
daltaparin (fragmin)
enoxaparin (lovenox)
tinzaparin (innohep)

MOA

Answer 5

inhibit factor Xa by antithrombin, some IIa effect

Question 6

LMWH hold times

Answer 6

spinal/epi = 12 hrs after last dose, or 24 hrs if high dose
epi cath insert = 4 hrs before a dose
epi cath removal = 2-4 hrs before dose, 12 hrs after last

restart - atleast 24 hrs post op, dc cath first

Question 7

Danaparoid (Orgaran) MOA

Answer 7

anti-Xa

Question 8

Oral Xa Inhibitors

Answer 8

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)

Question 9

Oral Xa Inhibitors
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)

hold times

Answer 9

atleast 3-5 days pre-neuraxial block

Rivaroxaban (Xarelto) = 24 hrs pre
Apixaban (Eliquis) = 48 hrs pre
Edoxaban (Savaysa) 
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa

Question 10

Oral Xa Inhib
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa

restart

Answer 10

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)

*when hemodynamically stable, post spinal - 24 hrs for low risk, 48-72 hrs for high risk

Question 11

Reversal agent for Xa inhibitors?

Answer 11

Adexanet (Andexxa)

*rivaroxaban and apixaban

Question 12

Not yet approved reversal…

Answer 12

Ciraparantag

hydrogen bond

Question 13

Betrixaban (Bevyxxa)

Answer 13

VTE px for inpatient

• do not remove epi cath < 72 hrs after dose
• do not admin next dose < 5 hrs after removal

Question 14

Direct Thrombin Inhibs

Answer 14

Argatroban
Dabigatran (Pradaxa)
**no reversal

Question 15

Dabigatran (Pradaxxa)

Answer 15

hold 4-5 days for neuraxial block
CrCl > 50 = hold 1-2 days
CrCl < 50 = hold 3-5 days

Question 16

Warfarin

Answer 16

alters vit k - cant make 2, 7, 9 & 10
stop 5 days pre-op
dose based on INR

Question 17

PAI’s: ADP receptor antagonists

Answer 17

clopidogrel (plavix)
ticlopidyne (ticlid)
prasugrel (effient)
ticagrelor (brilanta)

Question 18

clopidogrel (plavix)
ticlopidyne (ticlid)
prasugrel (effient)
ticagrelor (brilanta)

stop times

Answer 18

clopidogrel (plavix) = 7 days
ticlopidyne (ticlid) = 10-14 days
prasugrel (effient) = 7 days
ticagrelor (brilanta) = 5 days

Question 19

PAI’s: GP IIa/IIIb Receptor Inhib…

Answer 19

abciximab (reopro)
eptifatibe (integrillin)
tirofiban (aggrastat)

Question 20

abciximab (reopro)
eptifatibe (integrillin)
tirofiban (aggrastat)

stop times

Answer 20

abciximab (reopro) = 24-48 hrs
eptifatibe (integrillin) = 4-8 hrs
tirofiban (aggrastat) = 4-8 hrs