VTE

Question 1

NOACs/DOACs

Answer 1

-direct thrombin inhibitor (dabigatran)
-factor Xa inhibitors (rivaroxaban, apixaban, edoxaban)

Question 2

Dabigatran VTE indications

Answer 2

-postop prophylaxis (hip)
-Afib
-DVT/PE tx

Question 3

NOAC indications

Answer 3

-all Afib and DVT/PE tx

Question 4

Rivaroxaban indications for VTE

Answer 4

-post-op prophylaxis
-prevention of recurrent DVT/PE
-VTE prophylaxis
-Afib and DVT/PE tx

Question 5

Apixaban indications

Answer 5

-pot-op
-precention of DVT/PE
-afib and DVT/PE tx

Question 6

Edoxaban VTE indication

Answer 6

-only afib and DVT/PE tx

Question 7

Dabigatran dosing for post-op prophylaxis

Answer 7

-110mg qd (1-4 after and hemostasis)
-not on 220mg qd 28-35 days
-hip replacement only

Question 8

Afib dosing

Answer 8

-20mg Rivaroxaban qd
-60mg Edoxaban qd
-Apixaban*

Question 9

Apixiban for afib dosing

Answer 9

-renal adjustment if SCr < 1.5mg/dl, over age 80 under 60kg = 2.5mg BID (needs only 2 factors)
-ESRD on dialysis: 5mg BID reduce to 2.5mg if over 80 and under 60kg

Question 10

Edoxaban for afib

Answer 10

-60mg qd
-do not use if CrCl >95ml/min

Question 11

DVT/PE tx dosing

Answer 11

-Dabigatran requires 5-10days parenteral anticoagulation
-Rivaroxaban 15mg BID x 3 weeks then 20 mg qd
-Apixaban 10mg BID x 7 dyas then 5mg BID
-Edoxaban 60mg (30mg if under 60kg) and requires 5-10 day parenteral anticoagulation

Question 12

Prevention of recurrent DVT/PE dosing

Answer 12

-Rivaroxaban 20 mg
-Apixaban 2.5mg BID
-after initial 6 months of treatment

Question 13

VTE prophylaxis dosing

Answer 13

-Rivaroxaban 10mg qd 31-39 days

Question 14

Warfarin dosing

Answer 14

-5mg qd initial
-10mg qd x 2 days if healthy outpatient
-overlap w UFH/LMWH/Xa for at least 5 days and until INR is therapeutic
-adj weekly dose to acheive therapeutic INR

Question 15

Recommended INR goal of 2-3

Answer 15

-prophylaxis of VTE
-tx of VTE or PE
-prevention
-antiphoshpholipid antibody system
-MECHANICAL VALVE AORTIC

Question 16

Recommended INR goals

Answer 16

-1.5-2: aortic replacement
-2.5-3.5: MITRAL mechaninal heart valve

Question 17

INR initial monitoring

Question 18

5 Ds

Answer 18

-Drugs
-Diseases
-Doses
-Diet
-Drink

Question 19

Warfarin dosage adjustment

Answer 19

-bleeding
-Thromboembolic complications
-Rx changes
-diet
-activity
-alcohol use
-adverse effects
-OTC drug use
-drug interaction screening

Question 20

Warfarin dosage protocol if goal is 2-3

Answer 20

-INR < 2-3.5: inc/dec 5%-15%
-INR > 3.5:hold 0-1 doses inc by 10-15

Question 21

Warfarin dosage protocol if goal is 2.5-3.5

Answer 21

-2.5-4
=4-2.5

Question 22

Invasive procedures

Answer 22

-bridging before invasive surgeries
-stop warfarin 5 days before
-give LMWH or UFH until procedure
-stop LMWH 24h before surgery
-stop IV UFH 4-6h before procedure
-resume warfarin 12-24h after surgery