VTE quiz Flashcards
Unfractioned heparin
-anticoagulant
-dec platelets
-aPTT monitoring
-can cause HAT or HIT
HAT
-non-immune
-dont need to treat
HIT
-immune
-stop heparin
-give dif anticoagulant
-dont give warfarin is platelet count > 150k
LMWH
-better than UFH
-reduced risks
-monitor antiXa levels in children, kidney failure, obesity, pregnancy
-enoxaparin
-dalteparin
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
HIT tx options
-Fondaparinux
-Lepirudin
-Bivalirudin
-Argatroban
Warfarin
-1-6mg
-2.5, 7.5, 10mg
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
-
Dabigatran
-inhibits thrombin
-caution kidney function, age
-reversed by idarucizumab, charcoal, dialyzable
Rivaroxaban
-
Chadsvasc score
-only for afib pt
Virchow’s Triad
-hypercoaguable state
-circulatory stasis
-endothelial injury
DVT nonpharma tx
-bed rest
-elevate feet
-pain management
-compression stockings
PE nonpharma tx
-Oxygen
-mechanical ventialation
LMWH vs UFH
-reduced protein binding
-predicatble dose response
-longer half-life
-smaller molecule (absoroption)
-less HIT risk
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
