Orthopedic surgery

Question 1

Meds to hold prior to surgery:

Answer 1

antithrombotic therapy
cardiac meds
antidiabetic meds
herbal meds

Question 2

The higher the thromboembolic risk the greater the importance of minimizing the interval without anticoagulation.

a. true
b. false

Answer 2

a. true

Question 3

Which are higher thromboembolic risk mechanical or natural heart valves?

Answer 3

mechanical

Question 4

What Afib CHADS VASC score is high thrombotic risk?

Answer 4

7-9

Question 5

Afib Stroke or TIA within __ months is high thromboembolic risk

Answer 5

3

Question 6

__ valvular heart disease is high thromboembolic risk

Answer 6

rheumatic

Question 7

Recent VTE within __ months is high thromboembolic risk

Answer 7

3

Question 8

Stroke or TIA within __ months of mechanical heart valve is high thromboembolic risk

Answer 8

6

Question 9

What Afib CHADS VASC score is moderate thromboembolic risk?

Answer 9

4-6

Question 10

What Afib CHADS VASC score is low thromboembolic risk?

Answer 10

0-3

Question 11

VTE within __ to __ months is moderate thromboembolic risk

Answer 11

3, 12

Question 12

Orthopedic (joint arthroplasty, foot/hand/shoulder) surgery __ surgical bleed risk

a. high
b. low

Answer 12

a. high

Question 13

D/c warfarin __ days prior to elective surgery in pts requiring temporary interruption of therapy

Answer 13

5

Question 14

Consider bridging warfarin with what in preoperative pts at high risk for thromboembolism?

Answer 14

LMWH or heparin products

Question 15

In pts receiving bridge therapy with UFH stop therapy __ to __ hours before the surgery

Answer 15

4, 6

Question 16

In pts seeking bridge therapy with LMWH stop therapy __ hours before the surgery

Answer 16

24

Question 17

Resume LMWH therapy __ to __ hours after surgery if pt is undergoing high bleeding risk surgery

Answer 17

48, 72

Question 18

Preoperative DOACs: CrCl > 50

hold DOACs how many days before minor surgery?

Answer 18

1

Question 19

Preoperative DOACs: CrCl < 50

Which DOAC is held 4 days for major surgery if CrCL < 50?

Answer 19

dabigatran

others are 3-4

Question 20

Preoperative DOACs:

Which DOAc is held at least 2 days if CrCl < 50?

Answer 20

dabigatran

others are 1-2 days

Question 21

Preoperative DOACs:

Which DOAC is held 2-4 days before major surgery if CrCl is < 50?

Answer 21

dabigatraN

Question 22

Do not have to d/c warfarin if minimal bleeding risk

a. true
b. false

Answer 22

a. true

just have to make sure there are no bleeding signs

Question 23

Stop aspirin __ to __ days before surgery if pt is at low risk for cardiovascular event

Answer 23

7, 10

Question 24

consider deferring surgery if patient has a __ on dual antiplatelet therapy

Answer 24

coronary stent

at least 6 weeks after bare metal stenting and 6 months after drug eluting

Question 25

Stop P2Y12 inhibitors (clopidogrel, prasugrel) __ to __ days before surgery

Answer 25

5, 10

Question 26

Stop ticagrelor __ days before surgery

Answer 26

5

Question 27

Stop cilostazol how many days before surgery?

Answer 27

2-3

Question 28

2 major general surgery VTE risk factors:

Answer 28

major orthopedic surgery (total knee or hip arthroplasty) | fracture of pelvis, hip, long bones

Question 29

Age > __ years is a cancer VTE risk factor

Answer 29

40

Question 30

What is the Caprini risk assessment used for?

Answer 30

assessing VTE risk

Question 31

What is preferred Tx for VTE prophylaxis in pts undergoing total hip/knee arthroplasty?

Answer 31

DOACs DOACs > LMWH > warfarin

Question 32

Is LMWH or UFH preferred for pts undergoing total hip/knee arthroplasty?

Answer 32

LMWH

Question 33

Pts undergoing hip fracture repair should use __ or __ for VTE prophylaxis

Answer 33

LMWH, UFH

Question 34

Avoid rivaroxaban and dabigatran for VTE prophylaxis if CrCl is < __

Answer 34

30

Question 35

Avoid what two DOACs for VTE prophylaxis if CrCl < 30?

Answer 35

rivaroxaban | dabigatran

Question 36

What is warfarin INR goal for VTE prophylaxis?

Answer 36

1.5-2 or 2-3

Question 37

Rivaroxaban, apixaban, dabigatran should be used minimum of how long for VTE prophylaxis?

Answer 37

10-14 days can be extended to 35 days

Question 38

LMWH (enoxaparin), UFH, and fondaparinux are used for minimum of how long for VTE prophylaxis?

Answer 38

10-14 days can extend to 35 days

Question 39

Avoid __ use for VTE prophylaxis if CrCl < 30 a. enoxaparin (LMWH) b. UFH c. fondaparinux

Answer 39

c. fondaparinux

Question 40

VTE prophylaxis enoxaparin (LMWH) dose?

Answer 40

30mg SQ once daily

Question 41

All pts should receive prophylactic antibiotic within how long before surgical incision?

Answer 41

1 hour

Question 42

Prophylactic antibiotics are d/c within how long after cardiac surgery?

Answer 42

48 hours 24 hours for others

Question 43

Two prophylactic antibiotics for pts with beta lactam allergy?

Answer 43

clindamycin | vancomycin

Question 44

What antibiotic is given for surgery prophylaxis?

Answer 44

cefazolin