Coagulation
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| What are the 3 basic risk factors for Virchow's Triad? | venous stasis, vascular damage, hypercoaguable state
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| Which part of the triad does smoking affect? | vascular damage
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| Which part of the triad does obesity and old age affect? | venous stasis
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| Which part of the triad does cancer and estrogen use affect? | hypercoaguable states
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| What is the most common inherited hypercoaguable condition? | Factor V leiden mutation
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| T or F: Signs and symptoms of DVT are neither sensitive or specific | TRUE
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| What is a common complication of DVT? | post thrombotic syndrome
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| What is the number one diagnostic test for PE? | ventilation-perfusion radionuclide scan
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| What is a complication of PE? | pulmonary hypertension
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| T or F: IVC Filter is only indicated for DVT treatment | FALSE
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| Where is the IVC filter placed? | inferior vena cava
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| Why are IVC filters bad? | increase long term risk of VTE
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| What anticoagulant is indicated for line flushing? | UFH
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| What is the MOA of UFH? | inhibits clotting factors currently in circulation
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| What factors does UFH effect? | XII, XI, IX, Xa, IIa (thrombin)
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| What is the IV dose for DVT/PE with UFH? | 80-100 units/kg bolus followed by 17-20 units/kg/hr IV drip
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| How do you adjust the UFH dose for treatment of VTE? | aPTT or antifactor Xa levls
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| What is the SQ dose for DVT/PE with UFH? | 333 units/kg followed by 250 units/kg every 12 hours
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| Does UFH need to be renally adjusted? | NO
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| When should aPTT and antifactor Xa levels be drawn? | 6 hours after starting dose (6 hours after any dose change)
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| What is the therapeutic range of aPTT? | 1.5-2.5x control
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| What is the therapeutic range of antifactor Xa? | 0.3-0.7 units/mL
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| What does LMHW have greater activity against? | factor Xa
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| LWMH has less incidence of what compared to UFH? | osteoporosis and HIT
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| What is the SQ dose for DVT/PE with Enoxaparin? | 1 mg/kg SQ every 12 hours
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| What is the SQ inpatient dose for DVT/PE with Enoxaparin? | 1.5 mg/kg SQ every 24 hours
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| How do you renally adjust for LMWH? | ClCr < 30 mL/min: 1 mg/kg SQ every 24 hours
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| What is dalteparin? | LMWH
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| What is the SQ dose for DVT/PE with Dalteparin? | 100 units/kg SQ every 12 hours
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| Which LMWH is dosed 175 units/kg SQ every 24 hours? | Tinzaparin
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| What weight do you use for anticoagulants? | actual body weight
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| What are common SE of heparins? | low platelets, osteoporosis, HYPERkalemia
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| Thrombocytopenia | platelet count <150,000
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| When is the onset for HAT? | 1-4 days
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| When is the onset for HIT? | 5-14 days
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| What causes HAT? | direct interaction between heparin and platelets
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| What causes HIT? | antibody mediated interaction
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| Can you continue heparin when a patient develops HAT? | YES
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| What medication should you give to patients who develop HIT? | direct thrombin inhibitors
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| What is fondaparinux? | factor Xa inhibitors?
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| What other medications are factor Xa inhibitors? | rivaroxaban and abixaban
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| Which factor Xa inhibitor is not approved for VTE? | abixaban?
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| Which factor Xa inhibitor is indicated for DVT prophylaxis? | fondaparinux?
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| Which factor Xa inhibitor is indicated for postoperative prophylaxis? | rivaroxaban
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| What is fondaparinux dosed by? | actual body weight
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| What is the fondaparinux dose for DVT/PE? | 5 mg SQ daily (<50 kg), 7.5 mg SQ daily (50-100kg), 10 mg SQ daily (>100kg)
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| What is the rivaroxaban dose for DVT/PE treatment? | 15 mg BID with food for 3 weeks, then 20 mg QD with food
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| What is the rivaroxaban dose for recurrent reduction DVT/PE? | 20 mg QD with food
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| What is the rivaroxaban dose for postoperative reduction DVT/PE? | 10 mg QD with food (up to 35 days)
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| Do factor Xa inhibitors require therapeutic monitoring? | NO
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| Can you develop HIT for Xa inhibitors? | YES
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| When are factor Xa inhibitors CI? | ClCr <30mL/min
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| Which medication has interactions with CYP3A4 (inhibitors/inducers? | rivaroxaban
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| What is the MOA of direct thrombin inhibitors? | inhibit BOTH circulating and clot-bound thrombin
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| What can DTI's never cause? | HIT
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| Which DTI requires dose reduction with liver disease? | argatroban
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| Which DTI requires dose reduction with renal disease? | bivalirudin
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| Which DTI is not approved for VTE treatment? | dabigatran
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| What do DTI agents increase? | INR levels
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| What labs should be taken every 6-12 months for all anticoagulants? | Hgb, Hct, platelets
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| What is the treatment for acute bleeding from anticoagulants? | FFP, packed RBCs
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| What is the black box warning for all anticoagulants? | neuraxial anesthesia (hematomas)
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| What is the MOA of warfarin? | inhibits production of several vitamin K dependent clotting factors
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| Which clotting factor has a half life of 4-6 hours? | VII
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| Which clotting factor has a half life of 8-10 hours? | Protein C
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| Which clotting factor has a half life of 20-30 hours? | IX
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| Which clotting factor has a half life of 24-40 hours? | X
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| Which clotting factor has a half life of 40-60 hours? | Protein S
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| Which clotting factor has a half life of 60-100 hours? | II
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| What is protime? | the time in seconds for a clot to form
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| What is the reliability of the result influenced by? | sensitivity of thromboplastin reagents
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| What is the equation for INR? | (PT patient/PT control)^ISI
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| How do you first monitor INR? | twice a week
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| How do you monitor INR after a dose change? | in 7-14 days
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| When is warfarin CI? | active or recent major bleed, alcohol/drug abuse, pregnancy, patient at risk for trauma or falls
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| When does purple toe syndrome typically occur? | 3-10 weeks after starting warfarin
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| What is the cause of warfarin induced skin necrosis? | deficiency in protein C or S
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| What should be given to patients with warfarin induced skin necrosis? | heparin
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| Which warfarin enantiomer is 4x more potent? | S (9/19)
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| If there is a transient drug interaction how do you change warfarin dose? | skip 1-2 doses
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| How does diarrhea effect INR? | increases
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| Which medication is most likely to increase a patient's INR? | metronidazole
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| Which OTC pain reliever is safest to take with warfarin? | APAP
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| How do grapefruit and cranberry juices effect INR? | increase
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| How does chronic alcohol effect INR? | decreases (binge drinking increases INR)
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| What does smoking while on warfarin do? | induce 1A2 (metabolism of R-isomer)
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