VTE

Question 1

Heparin Vs LMWH

Answer 1

Heparin carry high risk of bleeds but can be used in renal impairment. Monitor ATTP. Slower duration of action than LMWH.

LMWH- used in pregnancy. lower risk of OP and HIT

Question 2

Reversal agent for heparins?

Answer 2

Protamine. Works for Heparin but only partially for LMWH

Question 3

Drug class- side effects (Heparin)

Answer 3

Haemorrhage
HIT- can occur days after dose so monitor for reduction of platelets by 30%
Osteoporosis
Hyperkalaemia

Question 4

Heparin monitoring requirements

Answer 4

platelets and serum potassium

Question 5

Alternative to heparin if HIT occurs

Answer 5

Danaparoid

Question 6

What is warfarin

Answer 6

Vit K antagonist

Question 7

MHRA alert for Vit K antagonists

Answer 7

changes in liver function secondary to HEP C treatment can may affect efficacy of Vit K antagonists

miconazole OTC interacts

Stop if signs of painful rash- calciphylaxis

Question 8

Warfarin tab strengths and colours

Answer 8

0.5- white
1mg- brown
3mg- blue
5mg- pink

Question 9

General INR

Answer 9

2.5 for treatment of VTE, AF, cardioversion, MI

Question 10

what is INR of 3.5 indicated for

Answer 10

recurrent VTE, prosthetic valves

Question 11

Duration of anticoagulation therapy

Answer 11

6 weeks for deep calf vein
3 months for provoked VTE (e.g. caused by surgery, COC etc)
at least 3 months for recurrent unprovoked

Question 12

How many days before surgery should warfarin be stopped

Answer 12

5 days

Question 13

Patients having surgery at high risk of VTE on warfarin should do what?

Answer 13

stop warfarin and consider bridging therapy with LMWH

LMWH should be stopped at least 24 hours before surgery

Question 14

Patient counselling warfarin

Answer 14

doses 5mg initially 
maintenance is 3-9mg
brown tab 1mg 
blue tab 3mg 
pink tab 5mg 
yellow book and anticoag alert card 
regular INR monitoring every 3 months
stop on signs of bleeding gums etc
cant have with alcohol
cant have too many greeny leafs -  have balanced diet