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VTE Flashcards

1
Q

Unfractionated Heparin Abbreviation

A

UFH

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2
Q

Unfractionated Heparin Dosing

A

Weight based: 80 units/kg IV bolus, 18 units/kg/hr infusion

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3
Q

Unfractionated Heparin Side Effects

A 
Major bleeding
Osteoporosis (if long term)
Hypersensitivity
HIT
HAT
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4
Q

Unfractionated Heparin Monitoring

A

aPTT: Baseline, 6 hours after dose or dose change (x24h), daily after 1st day
Platelet: QOD until day 14

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5
Q

Enoxaparin Brand

A

Lovenox

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6
Q

Enoxaparin Dosing

A

Prophylaxis: 30mg SQ q12h OR 40mg SQ daily
Treatment (actual body weight): 1mg/kg SQ q12h OR 1.5mg/kg SQ daily
If CrCl is less than 30ml/min:
Prophylaxis: 30mg SQ daily
Treatment: 1mg/kg SQ daily

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7
Q

Enoxaparin Side Effects

A

Black box warning: Do NOT use with neural anesthesia/spinal puncture
Bleeding
Thrombocytopenia (less than UFH)
Delayed HS skin reactions

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8
Q

Enoxaparin Monitoring

A

If CrCl less than 30mL/min (severe kidney failure), children, obesity, long courses, pregnancy, monitor anti-Xa level 4-6h post.

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9
Q

Dalteparin Brand

A

Fragmin

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10
Q

Dalteparin Dosing

A

Prophylaxis: 2500-5000 IU SQ daily
Treatment: 200 IU/kg SQ daily (MAX 18000 IU)

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11
Q

Dalteparin Side Effects

A

Black box warning: Do NOT use with neural anesthesia/spinal puncture
Bleeding
Thrombocytopenia (less than UFH)
Delayed HS skin reactions

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12
Q

Dalteparin Monitoring

A

If CrCl less than 30mL/min (severe kidney failure), children, obesity, long courses, pregnancy, monitor anti-Xa level 4-6h post.

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13
Q

Tinzaparin Brand

A

Innohep

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14
Q

Tinzaparin Dosing

A

Treatment: 175 anti-Xa IU/kg SQ daily

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15
Q

Tinzaparin Side Effects

A

Black box warning: Do NOT use with neural anesthesia/spinal puncture
Bleeding
Thrombocytopenia (less than UFH)
Delayed HS skin reactions

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16
Q

Tinzaparin Monitoring

A

If CrCl less than 30mL/min (severe kidney failure), children, obesity, long courses, pregnancy, monitor anti-Xa level 4-6h post.

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17
Q

Fondaparinux Brand

A

Arixtra

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18
Q

Fondaparinux Dosing

A 
Prophylaxis: 2.5mg SQ daily (not for less than 50 kg or CrCl less than 30ml/min)
Treatment:
Less than 50: 5mg SQ daily
50-100kg: 7.5mg SQ daily
Greater than 100kg: 10mg SQ daily
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19
Q

Fondaparinux Side Effects

A

Bleeding

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20
Q

Fondaparinux Monitoring

A

Can monitor anti-Xa levels, but no routine monitoring

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21
Q

Rivaroxaban Brand

A

Xarelto

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22
Q

Rivaroxaban Dosing

A

DVT prophylaxis: 10mg PO daily 12-35 days
DVT/PE treatment: 15mg PO BID x3 weeks, then 20mg daily
NV Atrial fibrillation:
20mg PO daily

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23
Q

Rivaroxaban Side Effects

A

Bleeding

Black box warning: spinal/epidural hematoma and premature D/C increases risk thrombotic event

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24
Q

Rivaroxaban Monitoring

A

Caution with CYP3A4/P-gp

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25
Q

Edoxaban Brand

A

Savaysa

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26
Q

Edoxaban Dosing

A

DVT/PE treatment (after 5-10 days parenteral therapy): 60mg PO daily if CrCl is greater than 50 mL/min
30mg PO daily if CrCl 15-50 mL/min, body weight less than or equal to 60kg
NV atrial fibrillation:
60mg PO QD if CrCl 50-95 mL/min
30mg PO QD if CrCl 15-50 mL/min

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27
Q

Edoxaban Side Effects

A

Bleeding
Black box warning: spinal/epidural hematomas, premature discontinuation increases risk thrombotic event
Less efficacy in NVAF patient CrCl is greater than 95 mL/min

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28
Q

Edoxaban Monitoring

A

Caution with CYP3A4/P-gp

29
Q

Apixaban Brand

30
Q

Apixaban Dosing

A 
Pregnancy Class B!
DVT prophylaxis: 2.5mg PO BID
DVT/PE treatment: 10mg PO BID x7 days, then 5mg BID x6 months (2.5 after)
NV atrial fibrillation: 5mg PO BID OR 2.5mg PO BID if 2 of:
1) age ≥ 80 years
2) weight ≤ 60kg
3) SCr ≥ 1.5mg/dL 
OR dialysis + age ≥ 80 years
OR weight ≤ 60kg
31
Q

Apixaban Side Effects

A

Bleeding

Black box warning: spinal/epidural hematomas, premature discontinuation increases risk thrombotic event

32
Q

Apixaban Monitoring

A

Caution with CYP3A4/P-gp

33
Q

Lepirudin Brand

34
Q

Lepirudin Dosing

A

HIT: 0.15 mg/kg/h

35
Q

Lepirudin Side Effects

36
Q

Lepirudin Monitoring

A

Goal aPTT 1.5-2.5

Reduce dose if CrCl less than 60 ml/min

37
Q

Bivalirudin Brand

38
Q

Bivalirudin Dosing

A

HIT or UFH alternative during PCI: 0.7 mg/kg bolus + 1.75 mg/kg/h infusion

39
Q

Bivalirudin Side Effects

40
Q

Bivalirudin Monitoring

41
Q

Argatroban Brand

42
Q

Argatroban Dosing

A

HIT: 2 mcg/kg/min OR 0.5 mcg/kg/min if hepatic insufficiency

43
Q

Argatroban Side Effects

44
Q

Argatroban Monitoring

A

Elevates INR falsely; overlap with warfarin until INR ≥4

45
Q

Dabigatran Brand

46
Q

Dabigatran Dosing

A

DVT/PE treatment after 5-10 days parenteral anticoag: 150mg PO BID for CrCl ≥30 mL/min
NV atrial fibrillation:
150mg PO BID if CrCl greater than 30 mL/min
75mg PO BID if 15-30 mL/min

47
Q

Dabigatran Side Effects

A

Dyspepsia

Bleeding

48
Q

Dabigatran Monitoring

A

Recommend alternate greater than 75yo

Keep in manufacturer’s bottle

49
Q

tPA, Alteplase Brand

50
Q

tPA, Alteplase Dosing

A

10mg IV bolus + 90mg infusion over 2 hours

Most commonly for PE

51
Q

tPA, Alteplase Side Effects

52
Q

tPA, Alteplase Monitoring

53
Q

Reteplase Brand

54
Q

Reteplase Dosing

A

10 units IV over 2 minutes + second dose in 30 mins

For ACS only

55
Q

Reteplase Side Effects

56
Q

Reteplase Monitoring

57
Q

Tenecteplase Brand

58
Q

Tenecteplase Dosing

A

30mg + 5mg/10kg over 60kg up to 50mg as IV bolus

For ACS only

59
Q

Tenecteplase Side Effects

60
Q

Tenecteplase Monitoring

61
Q

Urokinase Brand

A

Abbokinase

62
Q

Urokinase Dosing

A

VTE treatment: 4400 units/kg bolus over 10 minutes + 4400 units/kg/hour for 12 hours

63
Q

Urokinase Side Effects

64
Q

Urokinase Monitoring

65
Q

Warfarin Brand

A

Coumadin, Jantoven

66
Q

Warfarin Dosing

A

Starting dose: 5 mg PO QD

Available as 1, 2, 2.5, 3, 4, 5, 6, 7.5, and 10mg tablets

67
Q

Warfarin Side Effects

A

Bleeding

Pregnancy Class X

68
Q

Warfarin Monitoring

A

CYP2C9, 3A4, 2C19, 1A2 interactions
Goal INR 2.0 – 3.0
*mechanical mitral/caged ball/high risk artificial valve
goal INR 2.5 - 3.5

Therapeutics (7 decks)

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