Thromboembolism

Question 1

Thromboembolism prophylaxis includes:

Answer 1

• low molecular weight heparin
• unfractionated heparin (if pt has renal failure) or
• fondaparinux sodium
• mechanical prophylaxis e.g. anti-embolism stockings can be offered to patients in whom pharmacological prophylaxis is contraindicated

Question 2

What thromboembolism prophylaxis can you offer for a patient whom pharmacological options are contraindicated?

Answer 2

• mechanical prophylaxis such as anti-embolism stockings

Question 3

What is the treatment for venous thromboembolism?

Answer 3

LMWH or unfractionated heparin PLUS an oral anticoagulant (e.g. warfarin) started at the same time

Question 4

Heparin is available in which dosage form?

Answer 4

Parenteral administration i.e. IV

Question 5

How is venous thromboembolism treated in pregnancy?

Answer 5

Heparins are used in pregnancy because they do not cross the placenta

Question 6

LMWH is preferred to unfractionated heparin because they have a lower risk of causing:

Answer 6

• osteoporosis

- heparin induced thrombocytopenia

Question 7

If a haemorrhage occurs it is usually enough to:

but if rapid reversal of effects of the heparin is required, what can you administer?

Answer 7

withdraw unfractionated or lmwh

protamine sulphate

Question 8

What is the antidote for heparin?

Answer 8

protamine sulphate

Question 9

Babies of mothers taking warfarin at the time of delivery need to be offered immediate prophylaxis with intramuscular ___________

Answer 9

phytomenadione (vitamine K)

Question 10

The main adverse effect of warfarin is ________

Answer 10

bleeding

Question 11

Which trimesters should warfarin be avoided in?

Answer 11

First and third

Question 12

CYP 450 inducers ______ the risk of warfarin metabolism and risk of clots

Answer 12

increase

Question 13

CYP450 inhibitors and many antibiotics ______ the risk of warfarin metabolism and increase the risk of bleeding

Answer 13

decrease

Question 14

Warfarin is taken via ____ route once a day at a starting dose of 5 - 10mg on day 1. After starting warfarin, it takes several days for full anticoagulation to be achieved. Pts needing immediate anticoagulation usually start both ______ (faster onset of action) and warfarin. ______ is removed when full anticoagulation with warfarin is achieved.

Answer 14

oral
heparin
heparin

Question 15

The INR of a patient is defined as:

Answer 15

The prothrombin time of a pt on warfarin divided by non-warfarinised ‘control’

Question 16

In AF, the target INR range is

Answer 16

2.0 to 3.0

Question 17

The higher the INR the ______ it takes for blood to clot. Therefore, the patient is at higher risk of ______

Answer 17

longer

bleeding