VTE important stuff Flashcards
The appropriate initial duration of anticoagulation therapy to effectively treat an acute first episode of VTE for all patients is ____ months
3
“Oral only” method of VTE Tx: List the first oral-only option and its steps
(starred slide)
1) Acute phase (days 0-7): Apixaban 10mg PO BID
2) Then Apixaban 5mg PO BID
3) Optional: reduce to Apixaban 2.5mg PO BID after first 6 months
What are the stages of VTE Tx?
(starred slide)
1) Acute phase (days 0-7): Tx
2) Early maintenance (days 8-90): Tx
3) Extended (day 91+): Prevention
“Oral only” method of VTE Tx: List the second oral-only option and its steps
(starred slide)
1) Rivaroxaban 15mg PO BID x first 21 days
2) Rivaroxaban 20mg PO Qday
3) Optional: Reduce to Rivaroxaban 10mg PO Qday after first 6 months
List the 2 steps of the “switch” method of VTE Tx
(starred slide)
1) UFH, LMWH, fondaparinux (all SC) x first 5 days
2) Dabigatran 150mg PO BID
OR
Edoxaban 60mg PO Qday
List the 2 steps of the “overlap” method of VTE Tx
(starred slide)
1) UFH, LMWH, or fondaparinux (all SC) x first 5 days
2) Warfarin PO daily ovarlapped with the SC anticoag for at least 5 days
(AND the INR >/= 2.0, then dose adj. to INR target 2.5 (range 2-3))
Direct oral anticoagulants (DOAC): List 2 of these
Apixaban (Eliquis) and rivaroxaban (Xarelto)
DOACs:
1) List 4 factor Xa inhibitors
2) List a direct factor IIa (thrombin) inhibitor
1) Rivaroxaban, apixaban, edoxaban, and betrixaban (Bevyxxa)
2) Dabigatran
1) LMWH and UFH reversal agent is what?
2) Fondaparinux reversal agent is what?
1) IV protamine sulfate
2) No specific antidote
1) How do you reverse Dabigatran?
2) How do you reverse Apixaban or Rivaroxaban?
1) Idarucizumab
2) Andexanet
Warfarin: Injectable anticoagulation should overlap with warfarin therapy for at least ___ days and until an INR ≥___ has been achieved for at least ____ hours.
1) 5 days
2) 2
3) 24 hours
Most people start on what dose of Warfarin?
5mg
Warfarin:
1) Maintenance dose changes should not be made more frequently than every ____ days.
2) When adjusting maintenance warfarin doses, the weekly dose should be reduced or increased by ___% to ___% of the weekly dose.
1) 3 days
2) 5% to 25%
Most stable patients on Warfarin are tested approximately every ____ to ____ weeks
4 to 6
Warfarin: Why do we calculate weekly doses?
Patients may not take the same dose each day
What needs to be consistent when you’re taking Warfarin?
Leafy green veggies
Antibiotics can increase INR. Give examples of abx that do this
(“memorize this list”)
1) Metronidazole
2) Sulfamethoxazole / trimethoprim
3) Penicillins
4) Macrolides
5) Tetracyclines
True or false: The majority of patients with VTE do not require thrombolytic therapy [i.e. alteplase]
True
Pregnancy:
1) UFH and ________ do not cross the placenta and are preferred during pregnancy
2) Pregnant women with a history of VTE should receive VTE prophylaxis (w. enoxaparin) for _____ weeks after delivery.
1) LMWH
2) 6
Anticoagulation for acute VTE during pregnancy should continue for at least ____ weeks postpartum and a minimum total duration of _____ months
6; 3
Cancer-related VTE is associated with __________ higher rates of recurrent VTE and up to _________ higher rates of bleeding
threefold; sixfold
Treatment of cancer-related VTE with ____________ monotherapy rather than traditional warfarin-based therapy decreases recurrent VTE rates without increasing bleeding risk
LMWH
Stopping DOACs ____________ prior to invasive procedures is usually sufficient
2 days
