weber in-class

Question 1

what drug is a direct thrombin inhibitor?

Answer 1

dabigatran etexilate (pradaxa)

Question 2

what drugs are factor Xa inihibitors?

Answer 2

rivaroxaban (Xarelto)
apixaban (eliquis)
edoxaban (savaysa)

Question 3

what drugs are NOACs/DOACs?

Answer 3

direct thrombin inhibitors
factor Xa inhibitors

Question 4

what are the indications of NOACs/DOACs?

Answer 4

postop prophylaxis
non-valvular afib
DVT tx
PE tx
indefinite anticoag –> secondary prevention of recurrent DVT and/or PE
VTE prophylaxis

Question 5

what NOAC/DOAC(s) can treat postop prophylaxis?

Answer 5

dabigatran –> hip only
rivaroxaban
apixaban

Question 6

what NOAC/DOAC(s) can treat non-valvular afib?

Answer 6

all

Question 7

what NOAC/DOAC(s) can treat DVT/PE?

Answer 7

all

Question 8

what NOAC/DOAC(s) can be used for secondary prevention of recurrent DVT/PE

Answer 8

rivaroxaban
apixaban

Question 9

what NOAC/DOAC(s) can treat VTE prophylaxis?

Answer 9

rivaroxaban

Question 10

how should dabigatran be dosed for postop prophylaxis?

Answer 10

1 dose before surgery
hold day of surgery until after homeostasis
maintenance dose (2x pre-surgery) for a total duration of 28-35 days

Question 11

what NOAC/DOAC is used in hip replacement only?

Answer 11

dabigatran

Question 12

when should a small dose of apixaban be considered in afib?

Answer 12

need 2 of the following:
over 80 yos
body weight under 60kg
SrCr greater than 1.5mg

Question 13

when is edoxaban not recommended in afib?

Answer 13

when CrCl is greater than 95 mL/min and under 15 mL/min

Question 14

what NOAC/DOAC(s) require parenteral anticoagulation for DVT/PE tx?

Answer 14

dabigatran and edoxaban
requires 5-10 days

Question 15

how is rivaroxaban dosed in DVT/PE tx?

Answer 15

start out at 15mg BID x3 days
then 20mg qd

Question 16

how is apixaban dosed in DVT/PE tx?

Answer 16

start out at 10mg BID x7days
then 5mg BID

Question 17

what NOAC/DOAC(s) has weight based dosing in DVT/PE tx?

Answer 17

edoxaban
half the dose if under 60 kg

Question 18

when should a pt be switched to rivaroxaban and apixaban for secondary prevention?

Answer 18

after initial 6 months of tx

Question 19

what is the initial dose of warfarin?

Answer 19

5mg qd
healthy outpatients –> 10 mg x2d

Question 20

how should warfarin be overlapped?

Answer 20

UFH/LMWH/Xa for at least 5 days AND
until INR is therapeutics

Question 21

when is a recommended INR goal of 2.0-3.0?

Answer 21

prophylaxis of VTE
tx of VTE or PE
prevention of systemic embolism
antiphospholipid antibody syndrome
mechanical heart valve (aortic)

Question 22

when is a recommended INR goal of 2.5-3.5?

Answer 22

mechanical heart valve –> mitral, caged ball, high risk

Question 23

when should maintenance monitoring be adjusted?

Answer 23

after 2 consecutive INRs are within goal

Question 24

what are the 5Ds and the 2Bs?

Answer 24

drugs
diseases
doses
diet
drink
bruising/bleeding

Question 25

what is the main focus of the 5Ds?

Answer 25

if anything changes, the doctor needs to be notified!

Question 26

if the INR is suppose to be 2-3 and it reads as under 2.0, what should happen?

Answer 26

increase total weekly dose by 5-15%

Question 27

if INR is suppose to be 2-3 and it reads 3.1-3.5, what should happen?

Answer 27

decrease total weekly dose by 5-15%

Question 28

if INR is suppose to be 2-3 and it reads 3.5-4, what should happen?

Answer 28

hold 0-1 dose decrease by 10-15%

Question 29

if INR is suppose to be 2-3 and it reads over 4, what should happen?

Answer 29

hold 0-2 doses decrease by 10-15%

Question 30

when is bridging needed?

Answer 30

if patient is on warfarin and undergoing an invasive procedure

Question 31

how should bridging be carried out?

Answer 31

stop warfarin 5 days before surgery give LMWH or UFH until procedure resume warfarin 12-24 hours after surgery assuming adequate homeostasis

Question 32

when should LMWH be stopped before procedure?

Answer 32

only use for bridging stop 24 hour before procedure

Question 33

when should UFH be stopped before procedure?

Answer 33

only IV use for bridging stop 4-6 hours before procedure

Question 34

how should NOACs be bridged?

Answer 34

they should not be just stop x hours before procedure based on CrCl and drug type