Treatment of dvt/pe Flashcards
Name your anticoagulants and which is preferred
heparin
Lovenox
Factor Xa inhibitors (DOACs) ** preferred **
Surgical: IVC filter
Heparin dosing
For PE
5000 u IV bolus, then 1200 u/hr min
Check aPTT q6h
– goal 1.5-2.5x normal
Transition to 10,000 u SC BID or Warfarin at 5 days
Check plt count in 2-3 days to look for HIT
Lovenox dosing
1.5 mg/kg SC daily for 5-10 days
Can transition to warfarin @ 3 days
DOACs
only for the hemodynamically stable pt
Kidney fx is good - CrCl >30 ml/min
Can tolerate PO and has no malaborsoption problems
Apixaban, rivaroxaban are monotherapy
Edoxaban and dabigatran are given after a 5 day course of IV anticoagulants
DOACs are first line. When do you use IV unfractionated heparin first line?
hemodyanmically unstable
renal insufficiency CrCl <30 ml/min
Obesity > 150 kg
High risk of bleeding
empiric anticoagulation during workup of PE
When is IVC filter indicated
recurrent DVT/PE
High risk thrombophilia
unstaable patients
Therapeutic monitoring for
Heparin
Lovenox
Warfarin
DOACs
Heparin: aPTT 1.5-2.5x normal
Lovenox: Anti-Factor Xa activity (0.6-1.0 units/ml), test 4 hours after first dose
– in pregnancy, monitor q4-6w
Warfarin: INR 2-3, GOAL 2.5
DOACs: no monitoring
If HIT? switch to what anticoagulant
argatroban
Warfarin MOA
1972: acts on factors 10, 9, 7, 2
Lovenox/heparin MOA
UH: binds to antithrombin which inhibits thrombin
Lovenox: inhibits factor Xa
DOACs MOA
thrombin inhibitor, factor Xa inhibitor directly
Warfarin teratogenic effects
fetal bleeding because it crosses placenta
stippled epiphyses
limb and nasal hypoplasia
Unfractionated heparin/LMWH s/e
maternal thrombocytopenia
osteoporosis (long term use)
HIT (more with heparin)
DOACs s/e
excessive bleeding, can cause uterine/placental bleeding
contraindicated in pregnancy/breastfeeding
Half life of warfarin, heparin/lmwh, DOACs
warfarin: 4 hrs
UH: 1.5 hr SC, 30 min IV
LMWH: 4 hrs
DOACs: 5-12 hrs depending on med
