VTE/PE

Question 1

What is the preferred treatment for VTE in pregnancy?

Answer 1

LMWH

Question 2

Why are LMWH preferred in pregnancy?

Answer 2

Rapidly eliminated
Less risk of osteoporosis
Less risk of heparin-induced thrombocytopenia
Doesn’t cross the placenta

Question 3

Edoxaban class?

Answer 3

Inhibitor of factor Xa

Question 4

Treatment of VTE with a LMWH + what?

Answer 4

Oral anticoagulant

Usually warfarin for at least 5 days or until INR is >/= 2

Question 5

Reversal of UFH/LMWH?

Answer 5

Protamine sulfate

Partially reverses LMWH

Question 6

Warfarin reversal agent?

Answer 6

VK

Question 7

Edoxaban treatment depends on what?

Answer 7

Risk of VTE vs risk of bleeding

Question 8

Do you stop LMWH before labour?

Answer 8

Yes.

LMWH are stopped at onset of labour and continued after depending on specialist decision

Question 9

When should LMWH be started in pregnancy women?

Answer 9

6 weeks since giving birth/termination or miscarriage

Should be given for at least 7 days/until VTE risk has reduced

Question 10

Reversal of Dabigatran?

Answer 10

Idaruzumab

Question 11

Edoxaban dosing for VTE/PE

Answer 11

<61 kg = 30 mg OD

> 61 kg = 60mg OD

Question 12

Edoxaban interactions and advise?

Answer 12

Erythromycin, ketoconazole, ciclosporin and dronedarone

Reduce dose to 30mg OD

Question 13

Edoxaban and rental monitoring

Answer 13

Avoid <15 ml/min

Reduce dose to 30 mg OD if 15-50ml/min

Question 14

Liver monitoring in edoxaban

Answer 14

LT X2 or bilirubin x1.5 then caution

Avoid in sever hepatic disease/impairment

Question 15

Rivaroxaban, apixaban and edoxaban class

Answer 15

Factor Xa inhibitors

Question 16

Rivaroxaban dose for hip and knee replacement

Answer 16

Knee = 10mg OD 2 weeks

Hip = 10mg OD FOR 5 weeks

Question 17

Rivaroxaban treatment for DVT/PE

Answer 17

15mg BD 21 days then 20 mg OD thereafter

Unless CrCl = 15-49 ml/min then 15mg OD thereafter

Question 18

Rivaroxaban to avoid when CrCl is …?

Answer 18

<15 ml/min

Question 19

Apixaban dose in hip and knee replacement prophylaxis

Answer 19

Hip = 2.5 mg BD 32-38 days

Knee = 2.5 mg BD 10-14 days

Question 20

Apixaban treatment dose for DVT/PE?

Answer 20

10mg BD 7 days then 5mg BD thereafter
Unless CrCl 15-29 ml/min

Then loading dose and then 2.5 mg BD thereafter

Question 21

Apixaban avoid when renal function is….?

Answer 21

<15 ml/min

Question 22

Apixaban liver monitoring

Answer 22

LT x2 and bilirubin x1.5 caution

Avoid in sever hepatic disease and dysfunction