Anticoagulation

Question 1

Virchow Triad (factors that can lead to anticoagulation)

Answer 1

• blood vessel injury
• blood stasis
• pro-thrombotic conditions

Question 2

What factor does Riva, Apixa, Edoxaban, and Fondaparinux inhibit?

Answer 2

Xa

Question 3

What factors do Heparins (UFH, LMWH) target?

Answer 3

• Xa
• IIa

Question 4

What factors does Warfarin inhibit?

Answer 4

SNOT
- VII (seven)
- IX (Nine)
- X (Ten)
- II (Two)

Question 5

What factors do Argatroban, Bivalirudin, and Dabigatran inhibit?

Answer 5

IIa

Question 6

When is Warfarin preferred over DOACs?

Answer 6

• AF with mod-severe mitral stenosis or a mechanical heart valve
• VTE Tx w/ mechanical heart valve or triple-antiphospholipid syndrome

Question 7

Which DOAC has the highest risk of bleeding and should be avoided for long-term Tx of AF/VTE in older adults?

Answer 7

Rivaroxaban

Question 8

UFH doses

Answer 8

• VTE PTx: 5,000 units Q8-12H
• VTE Tx: 80 u/kg IVB, then 18 u/kg/hr
• ACS/STEMI Tx: 60 u/kg IVB, then 16 u/kg/hr

Question 9

HIT Dx and Tx

Answer 9

• Dec in platelets > 50% from BL
• 5-10d after start of heparin Tx
• Tx w/ Argatroban (bivalirudin if cardiac surgery or PCI)
• Fonda used off-label for Tx

Question 10

UFH/LMWH Antidote

Answer 10

• Protamine (1 mg protamine reverses 100 units of heparin)

Question 11

Lovenox doses

Answer 11

VTE PTx: 30mg q12 or 40mg q24 (CrCl<30: 30mg q24)
- VTE, UA/NSTEMI Tx: 1mg/kg q12 or 1.5mg/kg q24 (CrCl<30: 1mg/kg q24)

Question 12

Apixaban doses

Answer 12

• AF: 5 mg BID (if 2 are true: ≥80yo, wt≤60kg, or SCr ≥1.5: 2.5 mg BID)
• VTE Tx: 10 mg BID x7d, then 5 mg BID (3-6mo)

Question 13

Rivaroxaban Doses

Answer 13

• AF: CrCl>50: 20 mg QD, CrCl<50:15 QD w/ evening meal (both)
• VTE Tx: 15 mg BID x21d, then 20 mg QD w/ food
• CAD/PAD: 2.5 mg BID + ASA81

Question 14

Conversion Between Anticoags

Answer 14

• READ: stop warf and convert to… R when INR<3, E when INR≤2.5, A when INR<2, D when INR<2
• Stop R,E,A and bridge to warfarin

Question 15

When is INR goal: 2.5-3.5

Answer 15

Pt has a mechanical mitral valve or two mechanical heart valves

Question 16

What will DEC INR?

Answer 16

CYP inducers (PS-PORCS)
- Phenytoin
- Smoking
- Phenobarb
- Oxcarbazepine
- RIFAMPIN
- Carbamazepine
- St. John’s wort

Question 17

What will INC INR?

Answer 17

CYP Inhibitors (G-PACMAN)
- Grapefruit juice
- Protease-i
- Azoles
- Cyclosporine/Cobicistat
- Macrolides
- Amiodarone (dec Warf, 30-50%)
- Non-DHP CCBs

Question 18

Supplements that INC bleeding risk

Answer 18

• 5 G’s (garlic, ginger, ginko, ginseng, and glucosamine)
• dong quai
• omega-3-fatty acids
• Vit E
• willow bark

Question 19

Bridge Keys

Answer 19

• Start Warf while on parenteral anticoag for AT LEAST 5 days and INR ≥2 for 24hrs

Question 20

Warfarin Colors

Answer 20

Please Let Greg Brown Bring Peaches To Your Wedding
- 1 mg (Pink)
- 2 mg (Lavander)
- 2.5 mg (Green)
- 3 mg (Brown)
- 4 mg (Blue)
- 5 mg (Peach)
- 6 mg (Teal)
- 7.5 mg (Yellow)
- 10 mg (White)

Question 21

Riva and Apixa Antidote

Answer 21

AndeXanet Alfa (AndexXa)

Question 22

Dabigatran antidote

Answer 22

Idarucizumab (praxbind)

Question 23

VTE Tx duration

Answer 23

• 3 months (provoked)
• 6 months with dec dose (unprovoked)

Question 24

CHADSVASc

Answer 24

• CHF: 1
• HTN: 1
• Age ≥75: 2
• Diabetes: 1
• Prior stroke/TIA or thromboembolism: 2
• Vascular disease (MI, PAD)
• Age 65-74: 1
• Female: 1

Question 25

CHADSVASc indications

Answer 25

- M1/F2: anticoag may be considered - ≥M2/F3: anticoag IS recommended!