weber pre-lecture pt 3

Question 1

what is the targeted reversal of UFH/LMWH?

Answer 1

protamine sulfate

Question 2

what is the targeted reversal of dabigatran?

Answer 2

idarucizumab (praxbind)

Question 3

what is the targeted reversal of factor Xa inhibitors?

Answer 3

andexanet alfa

Question 4

what are some considerations of bleeding management?

Answer 4

activated charcoal within 2 hours of bleeding
in patients on hemodialysis, use dabigatran only
tranexamic acid

Question 5

what are the steps of bleeding management?

Answer 5

d/c medication
apply manual compression
maintain BP
surgical or radiological intervention
blood productions + prothrombin complex concentration + targeted antidotes

Question 6

what are some AE of protamine sulfate?

Answer 6

hypotension
bradycardia
fix through slow IV infusion rate with a max of 50 mg over 10 minutes

Question 7

what is the MOA of idarucizumab?

Answer 7

direct binder to dabigatran

Question 8

what are some AE of idarucizumab?

Answer 8

delirium
HA
hypokalemia
constipation
pneumonia
fever

Question 9

what is the monitoring schedule of idarucizumab?

Answer 9

baseline aPTT
repeat in 2 hours
every 12 hours until normal

Question 10

what is the MOA of andexant alfa?

Answer 10

binds and sequesters FXa inhibitors (rivaroxaban and apixaban)

Question 11

what is considered a low dose of andexant alfa?

Answer 11

400 mg IV bolus
4mg/min IV infusion

Question 12

what is considered a high dose of andexant alfa?

Answer 12

800 mg IV bolus
8 mg/minute IV infusion

Question 13

what are some AEs of andexant alfa?

Answer 13

local site infusion rxn
DVT
ischemic stroke
AMI
PE UTI
pneumonia

Question 14

how should bleeding be managed while on warfarin?

Answer 14

Vit K
Fresh Frozen Plasma (FFP)
Prothrombin complex concentrate (PCC)

Question 15

what is the Vit K dosing for warfarin bleeding management?

Answer 15

oral 5 mg tablets (preferred route)
parenteral 1mg/min max (do not go over due to anaphylaxis)

Question 16

how should PCC be monitored?

Answer 16

check INR before and 30-60 minutes after

Question 17

what should be done if the INR is between 4.5-10 while on warfarin?

Answer 17

if no evidence of bleeding –> avoid Vit K

Question 18

what should be done if the INR is over 10 while on warfarin?

Answer 18

if no evidence of bleeding –> oral vit K

Question 19

what should be done if there is major bleeding while on warfarin?

Answer 19

use PCC over FFP
may add vit K oral as well

Question 20

in warfarin reversal, what is rapid?

Answer 20

PCC (immediate replacement of Vit K-dependent clotting factors)

Question 21

in warfarin reversal, what is fast?

Answer 21

FFP (correction of coagulopathy is partial)

Question 22

in warfarin reversal, what is prompt?

Answer 22

IV vit K

Question 23

in warfarin reversal, what is slow?

Answer 23

oral vit K

Question 24

in warfarin reversal, what is very slow?

Answer 24

omit warfarin with no vit K

Question 25

what is the chance of VTE in medical patients w/o prophylaxis?

Answer 25

5-15%

Question 26

what is the chance of VTE in surgical pts w/o prophylaxis?

Answer 26

40-80%

Question 27

what are the options for VTE prophylaxis?

Answer 27

UFH LMWH Factor Xa inhibitors Vit K antagonists

Question 28

what is considered tx of patients with low risk?

Answer 28

no specific pharmacologic therapy recommended early and aggressive ambulation

Question 29

who is considered a moderate VTE risk?

Answer 29

general surgery pts acutely ill medication pts

Question 30

how should general surgery pts be treated for prophylaxis?

Answer 30

UFH, LMWH, and fondaparinux recommended continue 28 days after discharge

Question 31

how should acutely ill medical patients be treated for prophylaxis?

Answer 31

UFH, LMWH, fondaparinux --> all appropriate, no recommendation for duration Rivaroxaban --> 31-39 days total treatment Betrixaban --> 35-42 days total treatment

Question 32

who is considered high VTE risk?

Answer 32

orthopedic surgery (TKA or THA)

Question 33

how should orthopedic surgery pts be treated for prophylaxis?

Answer 33

UFH, LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (hip only), or vit K antagonists continue over 10-14 days post op (up to 35 days)

Question 34

how would you treat a high bleeding risk?

Answer 34

mechanical prophylaxis preferred so intermittent pneumatic compression devices, venous foot pumps, graduation compression socks

Question 35

what is a CHA2DS2-VASc score?

Answer 35

used only in AFib risk factors for stroke or systemic VTE

Question 36

what is the HAS-BLED score?

Answer 36

used only in AFib risk factors for bleeding

Question 37

why is Afib important in relation to VTE?

Answer 37

increases risk of stroke or systemic VTE by 5 fold anticoag therapy can reduce this risk and all-cause mortality

Question 38

what are factors of CHA2DS2-VASc?

Answer 38

congestive HF - 1 HTN - 1 over 75 yrs - 2 between 65-74 - 1 diabetes - 1 stroke/tia - 2 vascular disease - 1 female - 1

Question 39

what is recommended with a CHA2DS2-VASc score of 2?

Answer 39

oral anticoagulation

Question 40

what is the recommendation of a CHA2DS2-VASc score of 1?

Answer 40

no antithrombotic therapy OR oral anticoagulant OR antiplatelet (ASA)

Question 41

what is a prominent score of HAS-BLED?

Answer 41

equal to or greater than 3 high risk of bleeding --> caution and regular of the patient are recommended