Anticoagulation

Question 1

What conditions require anticoag

Answer 1

AF
Metallic heart valves
Nephrotic syndrome
Stroke prophylaxis

Question 2

Why need to rescribe LMWH with warfarin

Answer 2

Initially -> prothrobotic state
LMWH until INR in range
Can cause skin necroesis/repeat VTE if not

Question 3

Which rug is best used to anticoagulate in extremes of body weight

Answer 3

Warfarin ir LMWH

Question 4

What anticoag for poor renal fucntion

Answer 4

Warfarin

Question 5

What DOAC interact with drug wise

Answer 5

Antiepileptics

Question 6

What drug to use if goal INR is >3

Answer 6

Warfarin + LMWH - only way can increase intensity

Question 7

How long before surgery stop wargarin

Answer 7

• High risk of VTE
• AF w CHAD>4, recent CVA/TIA
• Metallic mitral valve - not aortic unless other risk factors

Question 8

When do you bridge warfarin before a surgery rather than stopping

Answer 8

• High risk of VTE
• AF w CHAD>4, recent CVA/TIA
• Metallic mitral valve - not aortic unless other risk factors
• Last dose 24 hours pre surgery - 50% before high risk if once daily dosing
• Restart 28 hours post surgery

Question 9

How do different DOACs affect lab tests

Answer 9

Dabigatran

• V prolonged PT, tends to prolong APTT

Rivaroxaban

• Prolong PT

Apixaban - often doenst affect blood sreen at all

Question 10

What do with DOACs before procedure

Answer 10

Low risk + normal renal function - stop 24 hours before

High risk and normal renal function

• Stop 48 hours before procedure
• Dont reintroduce until 48 hours after
• High thrombotic risk - thromboprophylais prior to reintroduction of DOAC

Question 11

How reverse warfarin

Answer 11

IV Vit K 5mg - 4-6 hours Beriplex 30U/kg - 15 mins (give with vit K)

Question 12

What use for unfract. heparin reversal

Answer 12

Stop infusion
Protamine

Question 13

What can protamine cause

Answer 13

reactions bradycardia and drop in BP

Question 14

Reversal of dabigatran

Answer 14

last 2 hours taken - activated charcoal
2 doses praxabind 2.5g 15 mins apart (idarucizumab)
Dialysis if not available

Question 15

How to reverse anti-Xa inhbitors

Answer 15

Activated cahrcoal if within 2 hours
No speciic antidote

Question 16

What can do to reverse DOAC if taken within last 2 hours

Answer 16

Activated charcoal