VTE quiz Flashcards by Brooke Thornburg

Unfractioned heparin

-anticoagulant
-dec platelets
-aPTT monitoring
-can cause HAT or HIT

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HAT

-non-immune
-dont need to treat

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HIT

-immune
-stop heparin
-give dif anticoagulant
-dont give warfarin is platelet count > 150k

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LMWH

-better than UFH
-reduced risks
-monitor antiXa levels in children, kidney failure, obesity, pregnancy
-enoxaparin
-dalteparin

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Fondaparinux

-prophylaxis after surgery
-tx DVT/PE
-do NOT use in renal function
-do NOT use w low body weight
-can use in HIT
-pregnancy category B

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HIT tx options

-Fondaparinux
-Lepirudin
-Bivalirudin
-Argatroban

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Warfarin

-1-6mg
-2.5, 7.5, 10mg

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Warfarin

-inhibits vit K, factor II, VII, IX, X
-monitor INR
-give vit k for reversal
-consider PCC + IV vit K if major bleeding reversal
-consider FFP then
-

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Dabigatran

-inhibits thrombin
-caution kidney function, age
-reversed by idarucizumab, charcoal, dialyzable

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Rivaroxaban

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Chadsvasc score

-only for afib pt

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Virchow’s Triad

-hypercoaguable state
-circulatory stasis
-endothelial injury

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DVT nonpharma tx

-bed rest
-elevate feet
-pain management
-compression stockings

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PE nonpharma tx

-Oxygen
-mechanical ventialation

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LMWH vs UFH

-reduced protein binding
-predicatble dose response
-longer half-life
-smaller molecule (absoroption)
-less HIT risk

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Warfarin genetic cariances

-CYP2C9
-VKORC1

Warfarin drug interactions

-inc INR: meronidazole, fluconazolem cirpo, bactrim
-dec INR: rifampin

Warfarin and alcohol

-acute: inc effect
-chronic: dec effect
-chronic w liver damage: inc effect, reduce dose

Antiplatelet use in VTE

-limited role
-consider aspirin in CHAD score 1
-consider dipyridamole in warfarin with prosthetic heart valves

Bleeding management

-d/c med, compress, watch BP
-consider blood products + PCC + targeted reversal

Bleeding tx

-activeated charcoal within 2 hours
-dabigatran for HD
-tranexamic acid

Targeted reversals

-protamine sulfate for UFH or LMWH
-idarucizumab for dabigatran
-andexanet for factor Xa inhibitors

Warfarin bleeding reversal

-vit K if INR over 10 w no bleeding
-PCC (rapid)
-FFP (fast)

Moderate VTE risk prophylaxis tx

-UFH, LMWH, factor Xa inhibitor (fondaparimux
-continue up to 28 days after discharge

Moderate VTE risk prophylaxis tx in acute illness

-UFH. LMWH, fondaparinux, rivaroxaban, betrixaban

High VTe risk prophylaxis tx

-orthopedic surgery -UFH, LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (hip), vit K antagonist -continue 10-14 days post op

CHAD score

-over 2= oral anticoagulation -1: none or oral or aspirin -only if afib

Dabigatran

-post-op prophylaxis -afib -DVT/PE tx -thrombin inhibitor

Rivaroxaban

-post-op prophylaxis -afib -tx -secondary prevention -VTE prophylaxis -not if CrCl < 30

Apixaban

-post-op -afib -DVT/PE tx -secondary prevention

Edoxaban

-afib -DVT tx

Warfarin intial dose

-5mg PO qd -overlap w UFA/LMWH/Xa for at least 5 days and until INR is therapeutic -adjust weekly dose

If goal INR 2-3

-less than 2: inc 5-15% -3.1-3.5: dec 5-15% -3.5-4: hold 0-1 dose, dec 10-15 -over 4: hold 0-2 doses, dec 10-15%

Warfarin adj 2.5-3.5

-less than 2.5: inc 5-15% -3.6-4: dec 5-10% -4-4.5: hold 0-1, dec 10-15% -over 4.5: hold 0-2, dec 10-15%

Bridging

-stop warfarin 5 days before surgery -give LMWH or UFH until procedure -stop UFH 4-6 h before -stop LMWH 24 hours before -resume warfarin 12-24h later