Last Minute Anti-Coagulation Ish

Question 1

Bolus Dose for UFH fir acute VTE

Answer 1

80 U/kg (Max = 10,000 units)

Question 2

Initial Infusion Rate for UFH

Answer 2

18 U/kg/kr (Max = 2,300 units/hr)

Question 3

UFH Maintenance Infusion Rate: Activated Partial Thromboplastin Time (seconds)

Answer 3

< 37 = 80 U/kg bolus then increase infusion by 4 U/kg/hr

37 - 47 = 40 U/kg bolus then increase infusion by 2 U/kg/hr

48 - 71 = No change

72 - 93 = Decrease infusion by 1 - 2 U/kg/hr

> 93 = Hold infusion for 1 hr, and then decrease by 3 U/kg/hr

Question 4

Hip replacement surgery (prophylaxis): Enoxaparin

Answer 4

• 30 mg SC q 12 hr
• Or
• 40 mg SC q 24 hr
• Extended prophylaxis may be given for up to 3 weeks

Question 5

Hip replacement surgery (prophylaxis): Dalteparin

Answer 5

Postoperative start: 2,500 units SC given after surgery, and then
5,000 units SC q 24 hr
•
•Or
Preoperative start (evening before surgery): 5,000 units SC
followed by 5,000 units SC 4-8 hr after surgery, and then 5,000
units SC q 24 hr
•
•Or
Preoperative start (day of surgery): 2,500 units SC 2 hr before
surgery, then 2,500 units given 4-8 hr after surgery, and then
5,000 units SC q 24 hr

Question 6

Knee replacement surgery (prophylaxis): Enoxaparin ONLY

Answer 6

•30 mg SC q 12 hr

Question 7

Abdominal surgery (prophylaxis): Enoxaparin

Answer 7

•40 mg SC q 24 hr

Question 8

Abdominal surgery (prophylaxis): Dalteparin

Answer 8

2,500 units SC q 24 hr or 5,000 units SC q 24 hr or 2,500 units
SC followed by 2,500 units SC 12 hr later and then 5,000 units
subcutaneous q 24 hr

Question 9

Acute Medical Illness (prophylaxis): Enoxeparin

Answer 9

•40 mg SC q 24 hr

Question 10

Acute Medical Illness (prophylaxis): Dalteparin

Answer 10

•5,000 units SC q 24 hr

Question 11

Deep Vein Thrombosis (with or without pulmonary embolism): Enoxaparin ONLY

Answer 11

• 1 mg/kg SC q 12 hr
• Or
• 1.5 mg/kg SC q 24 hr

Question 12

Venous Thromboembolism Treatment in Patients w. Cancer: Dalteparin ONLY

Answer 12

200 units/kg SC q 24 hr for 30 days, followed by 150 units SC q 24 hr

Question 13

What is contra in LMWH

Answer 13

• obese pts

- pts with renal failure

Question 14

Enoxaparin has been shown to be ______ in pregnancy

Answer 14

SAFE!

Question 15

DOACS are ______ recommended in pregnancy

Answer 15

NOTTTTTT

Question 16

For Heparin and pregnancy

Answer 16

-doesn’t cross placenta but can cause osteoporosis when used for long periods of time

Question 17

Acute Treatment During Pregnancy and Delivery: SHORT TERM

Answer 17

• LMWH
• Enoxaparin 1 mg/kg SC q 12 hr or 1.5 mg/kg q 24 hr
• Or
• Dalteparin 100 units/kg SC q 12 hr

•Or
•UFH
Initiate using weight-based IV therapy and adjust dose to achieve therapeutic anti-Xa level for at least
5 days
•
Transition to SC adjusted-dose UFH administered q 8-12 hr with mid-interval anti-Xa activity adjusted
to achieve an anti-Xa level of 0.3-0.7 unit/mL [kU/L

Question 18

Acute Treatment During Pregnancy and Delivery: LONG TERM

Answer 18

• LMWH
• Maintain initial LMWH dose regimen throughout pregnancy
• Or
• Alter LMWH dose in proportion to any weight change (usually gain)

•Or
•UFH
Obtain anti-Xa level at the midpoint of the dosing interval and adjust UFH dose to achieve an anti-Xa
level of 0.3-0.7 unit/mL [kU/L]

Question 19

How to measure Heparin

Answer 19

aPTT

Question 20

How to measure Warfarin

Answer 20

PT/INR

Question 21

If pt experiences HIT, don’t use

Answer 21

LMWH (Enoxaparin), Warfarin, UFH

Question 22

Most commonly used thrombolytic therapy for pts with PE

Answer 22

alteplase 100 mg infused via peripheral vein over 2 hours

Question 23

Before thrombolytic therapy for PE…

Answer 23

IV UFH should be administered in full therapeutic doses

Question 24

Avoid _______ during thrombolytic therapy (3 things)

Answer 24

• phlebotomy
• arterial puncture
• other invasive procedures

Question 25

aPTT _________ following the completion of thrombolytic therapy

Answer 25

should be measured

Question 26

During thrombolytic therapy, it is __________ to either continue or suspend IV UFH

Answer 26

acceptable; suspend is most common in the US