Venous Thromboembolism

Question 1

NOACs/DOACs

direct thrombin inhibitor (1)

Answer 1

dabigatran etexilate (Pradaxa)

Question 2

NOACs/DOACs

Factor Xa Inhibitors (3)

Answer 2

• rivaroxaban (Xarelto)
• apixaban (Eliquis)
• edoxaban (Savaysa)

Question 3

Only 3 NOACs are approved for post-op prophylaxis, what are they?

Answer 3

• dabigatran
• rivaroxaban
• apixaban

Question 4

Postoperative Prophylaxis (Dosing)

the only post-op prophylaxis dabigatran is approved for ___ replacement
- rivaroxaban and apixaban and approved for ___ and ___

NOT day of surgery; after hemostasis

Answer 4

• hip
• knee, hip

Question 5

Only 4 NOACs are approved for non-valvular a-fib, what are they?

Answer 5

• dabigatran
• rivaroxaban
• apixaban
• edoxaban

Question 6

Non-Valvular Atrial Fibrillation (Dosing) - apixaban

Renal Adjustment:
- look at ___ > 1.5 mg/dL

Answer 6

SCr

Question 7

Non-Valvular Atrial Fibrillation (Dosing) - apixaban

Consideration: 2 of the following
- older than or equal to ___ yo
- body weight less than or equal to ___ kg
- ___ greater than or equal to ___ mg/dL

Answer 7

• 80 yo
• 60 kg
• SCr, 1.5 mg/dL

Question 8

Non-Valvular Atrial Fibrillation (Dosing) - edoxaban

Consideration
- use is not recommended if CrCl > ___ mL/min

Answer 8

• 95

if your kidneys work too well, cannot use

Question 9

4 NOACs are approved for DVT/PE Treatment, what are they?

Answer 9

• dabigatran
• rivaroxaban
• apixaban
• edoxaban

Question 10

DVT/PE Treatment (Dosing)

Which NOAC/DOACs require 5-10 days of parenteral anticoagulation? (2)

Answer 10

• dabigatran
• edoxaban

Question 11

DVT/PE Treatment (Dosing) - edoxaban

if pt weight of less than or equal to ___ , use ___ mg daily

Answer 11

• 60 kg
• 30 mg

Question 12

Secondary Prevention of Recurrent DVT/PE (Dosing)

What NOAC/DOACs can be used for secondary prevention of DVT/PE after initial ___ months of primary treatment therapy? (2)

Answer 12

6 month
- rivaroxaban
- apixaban

Question 13

VTE Prophylaxis (Dosing)

If we were to assess a patient’s clotting risk as high (acutley ill, hospitalized, on bed rest), choose ____ for VTE prophylaxis

Answer 13

rivaroxaban

only NOAC approved for VTE prophylaxis

Question 14

Warfarin Dosing and Monitoring

• variable over time and between patients
• initial dose: ___ mg PO D
• healthy outpatients: ___ mg PO D x ___ days
• overlap with UFH/LMWH/Xa for at least ___ days AND until INR is in therapeutic range ( ___ - ___ )
• adjust weekly dose to achieve therapeutic INR

Answer 14

• 5 mg
• 10 mg, 2 days
• 5 days
• 2-3

Question 15

Recommended INR goals

INR goal of 2.5-3.5 is for ___

Answer 15

mechanical heart valves (mitral, caged ball, high risk)

Question 16

Recommended INR goals

INR goal of 1.5-2.0 is for ___

Answer 16

aortic valve replacement - mechanical On-X

Question 17

Recommeded INR goals

INR goal of 2.0-3.0 for
- prophylaxis of ___
- treatment of __ or ___
- prevention of systemic ___ (heart valves, AMI, valvular heart disease, a-fib)
- ___ antibody syndrome
- mechanical heart valve ( ___ )

Answer 17

• VTE
• VTE, PE
• embolism
• antiphospholipid
• aortic

Question 18

INR frequency monitoring - initial

• flexible initiation - ___ through day ___; then within ___ - ___ days
• average daily dose method - within ___ - ___ days, then within ___ week
• after hospital discharge (stable) - within ___ - ___ days
• after hospital discharge (unstable) - within ___ - ___ days
• first month of therapy - ___

Answer 18

• daily, 4, 3-5
• 3-5, 1
• 3-5
• 1-3
• weekly

Question 19

INR frequency monitoring - Maintenance therapy

• dose held today - within ___ - ___ days
• dose change today - within ___ - ___ weeks
• dosage change less than or equal to 2 weeks ago - within ___ - ___ weeks
• routine follow-up stable pt - every ___ - ___ weeks
• routine follow-up unstable pt - every ___ - ___ weeks
• consistently stable (no change in 6 months) - every ___ weeks

Answer 19

• 1-2
• 1-2
• 2-3
• 4-6
• 1-2
• 12