Pregnancy and Pediatrics

Question 1

what is the preferred anticoagulant for pts who are pregnant? and what is the dose?

Answer 1

LMWH (enoxaparin 1mg/kg SC Q12 hours)

Question 2

what is an alternative anticaoagulant to LMWH for pts who are pregnant ?

Answer 2

UFH

Question 3

what are the 2 doses that can be given for UFH in pregnant women?

Answer 3

333units/kg SC Bolus then 250mg/kg SC Q 12 hrs
or
80 units/kg IV bolus then 18 units/kg/H IV for 5 days then you can convert the total current daily dose to BID or TID

Question 4

when do you stop LMWH prior to delivery of baby?

Answer 4

24 hours prior to planned delivery and neuraxial blockade

Question 5

when do you stop UFH SC and IV prior to deliver

Answer 5

SC = 24 hours prior to planned delivery and assess CBC before admin of neuraxial anesthesia

IV = 4-6 hours prior “

Question 6

when do you resume LMWH post partum?
Vaginal delivery
Cesarean
what about if you receive neuroaxial blockade?

Answer 6

vaginal = no sooner than 4-6 hours post delivery
cesarean = no sooner than 6-12 hours post delivery
Neuroaxial blockade= no sooner than 24 hours after neuraxial blockage or 4 hours after cath removal

Question 7

when do you resume UFH (SC or IV)
vaginal
cesarean deliver
neuroacial blockade

Answer 7

vaginal = no sooner than 4-6 hours post delivery
cesarean delivery = no sooner than 12 hours
Neuraxial blockade = no sooner than 1 hour after neuraxial blockade or cath removal

Question 8

what is the most commonly used anticoagulant in children for PE/DVT?

Answer 8

LMWH

Question 9

Can DOACs be used in children?

Answer 9

ONLY if they weight greater than 50kg

Question 10

what are the baseline labs that need to be drawn prior to initiation of anticoagulation therapy in children?

Answer 10

PT
PTT
CBCp
and SCr

Question 11

what is the treatment dose of LMWH of premature neonates?

Answer 11

2mg /kg/dose SQ BID

Question 12

what is the treatment dose of LMWH for full term neonates (< 1 month of age)

Answer 12

1.7mg/kg/dose SQ BID

Question 13

what is the treatment dose of LMWH for 1-3 months children?

Answer 13

1.5mg/kg/dose SQ BID

Question 14

what is the treatment dose of LMWH for children > 3 months?

Answer 14

1mg/kg SQ BID

Question 15

what is the PPX dose of LMWH in children less than 2 months?

Answer 15

0.75mg/kg/dose SQ daily

Question 16

what is thePPX dose of LMWH in children greater than 2 months of age?

Answer 16

.5mg/kg/dose SQ daily

Question 17

when would you draw levels for LMWH ?

Answer 17

every 4 hours after 3rd or 4th dose

Question 18

what is the Tx target level for Anti XA monitoring for LMWH

waht about PPX level

Answer 18

TX: 0.5-1 IU/ml PEAK

PPX : 0.1-0.3 IU/Ml PEAK

Question 19

what what warfarin dose do you start in children who do not have liver dysfunction while inpt

Answer 19

0.2mg/kg (max 7.5mg daily)

Question 20

what warfarin dose you start in children with known liver dysfunction?

Answer 20

0.1mg/kg (max 5mg daily)

Question 21

what do you do with warfarin dose if child is on enteral feeding?

Answer 21

hold feeding 1-2 hours before and after warfarin

Question 22

can warfarin be placed through a J tube?

Answer 22

NO