VTE/PE Flashcards
What is the preferred treatment for VTE in pregnancy?
LMWH
Why are LMWH preferred in pregnancy?
Rapidly eliminated
Less risk of osteoporosis
Less risk of heparin-induced thrombocytopenia
Doesn’t cross the placenta
Edoxaban class?
Inhibitor of factor Xa
Treatment of VTE with a LMWH + what?
Oral anticoagulant
Usually warfarin for at least 5 days or until INR is >/= 2
Reversal of UFH/LMWH?
Protamine sulfate
Partially reverses LMWH
Warfarin reversal agent?
VK
Edoxaban treatment depends on what?
Risk of VTE vs risk of bleeding
Do you stop LMWH before labour?
Yes.
LMWH are stopped at onset of labour and continued after depending on specialist decision
When should LMWH be started in pregnancy women?
6 weeks since giving birth/termination or miscarriage
Should be given for at least 7 days/until VTE risk has reduced
Reversal of Dabigatran?
Idaruzumab
Edoxaban dosing for VTE/PE
<61 kg = 30 mg OD
> 61 kg = 60mg OD
Edoxaban interactions and advise?
Erythromycin, ketoconazole, ciclosporin and dronedarone
Reduce dose to 30mg OD
Edoxaban and rental monitoring
Avoid <15 ml/min
Reduce dose to 30 mg OD if 15-50ml/min
Liver monitoring in edoxaban
LT X2 or bilirubin x1.5 then caution
Avoid in sever hepatic disease/impairment
Rivaroxaban, apixaban and edoxaban class
Factor Xa inhibitors
Rivaroxaban dose for hip and knee replacement
Knee = 10mg OD 2 weeks
Hip = 10mg OD FOR 5 weeks
Rivaroxaban treatment for DVT/PE
15mg BD 21 days then 20 mg OD thereafter
Unless CrCl = 15-49 ml/min then 15mg OD thereafter
Rivaroxaban to avoid when CrCl is …?
<15 ml/min
Apixaban dose in hip and knee replacement prophylaxis
Hip = 2.5 mg BD 32-38 days
Knee = 2.5 mg BD 10-14 days
Apixaban treatment dose for DVT/PE?
10mg BD 7 days then 5mg BD thereafter
Unless CrCl 15-29 ml/min
Then loading dose and then 2.5 mg BD thereafter
Apixaban avoid when renal function is….?
<15 ml/min
Apixaban liver monitoring
LT x2 and bilirubin x1.5 caution
Avoid in sever hepatic disease and dysfunction
