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IS-4 Exam 4

Coagulation

QuestionAnswer
What are the 3 basic risk factors for Virchow's Triad? venous stasis, vascular damage, hypercoaguable state
Which part of the triad does smoking affect? vascular damage
Which part of the triad does obesity and old age affect? venous stasis
Which part of the triad does cancer and estrogen use affect? hypercoaguable states
What is the most common inherited hypercoaguable condition? Factor V leiden mutation
T or F: Signs and symptoms of DVT are neither sensitive or specific TRUE
What is a common complication of DVT? post thrombotic syndrome
What is the number one diagnostic test for PE? ventilation-perfusion radionuclide scan
What is a complication of PE? pulmonary hypertension
T or F: IVC Filter is only indicated for DVT treatment FALSE
Where is the IVC filter placed? inferior vena cava
Why are IVC filters bad? increase long term risk of VTE
What anticoagulant is indicated for line flushing? UFH
What is the MOA of UFH? inhibits clotting factors currently in circulation
What factors does UFH effect? XII, XI, IX, Xa, IIa (thrombin)
What is the IV dose for DVT/PE with UFH? 80-100 units/kg bolus followed by 17-20 units/kg/hr IV drip
How do you adjust the UFH dose for treatment of VTE? aPTT or antifactor Xa levls
What is the SQ dose for DVT/PE with UFH? 333 units/kg followed by 250 units/kg every 12 hours
Does UFH need to be renally adjusted? NO
When should aPTT and antifactor Xa levels be drawn? 6 hours after starting dose (6 hours after any dose change)
What is the therapeutic range of aPTT? 1.5-2.5x control
What is the therapeutic range of antifactor Xa? 0.3-0.7 units/mL
What does LMHW have greater activity against? factor Xa
LWMH has less incidence of what compared to UFH? osteoporosis and HIT
What is the SQ dose for DVT/PE with Enoxaparin? 1 mg/kg SQ every 12 hours
What is the SQ inpatient dose for DVT/PE with Enoxaparin? 1.5 mg/kg SQ every 24 hours
How do you renally adjust for LMWH? ClCr < 30 mL/min: 1 mg/kg SQ every 24 hours
What is dalteparin? LMWH
What is the SQ dose for DVT/PE with Dalteparin? 100 units/kg SQ every 12 hours
Which LMWH is dosed 175 units/kg SQ every 24 hours? Tinzaparin
What weight do you use for anticoagulants? actual body weight
What are common SE of heparins? low platelets, osteoporosis, HYPERkalemia
Thrombocytopenia platelet count <150,000
When is the onset for HAT? 1-4 days
When is the onset for HIT? 5-14 days
What causes HAT? direct interaction between heparin and platelets
What causes HIT? antibody mediated interaction
Can you continue heparin when a patient develops HAT? YES
What medication should you give to patients who develop HIT? direct thrombin inhibitors
What is fondaparinux? factor Xa inhibitors?
What other medications are factor Xa inhibitors? rivaroxaban and abixaban
Which factor Xa inhibitor is not approved for VTE? abixaban?
Which factor Xa inhibitor is indicated for DVT prophylaxis? fondaparinux?
Which factor Xa inhibitor is indicated for postoperative prophylaxis? rivaroxaban
What is fondaparinux dosed by? actual body weight
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)
What is the rivaroxaban dose for DVT/PE treatment? 15 mg BID with food for 3 weeks, then 20 mg QD with food
What is the rivaroxaban dose for recurrent reduction DVT/PE? 20 mg QD with food
What is the rivaroxaban dose for postoperative reduction DVT/PE? 10 mg QD with food (up to 35 days)
Do factor Xa inhibitors require therapeutic monitoring? NO
Can you develop HIT for Xa inhibitors? YES
When are factor Xa inhibitors CI? ClCr <30mL/min
Which medication has interactions with CYP3A4 (inhibitors/inducers? rivaroxaban
What is the MOA of direct thrombin inhibitors? inhibit BOTH circulating and clot-bound thrombin
What can DTI's never cause? HIT
Which DTI requires dose reduction with liver disease? argatroban
Which DTI requires dose reduction with renal disease? bivalirudin
Which DTI is not approved for VTE treatment? dabigatran
What do DTI agents increase? INR levels
What labs should be taken every 6-12 months for all anticoagulants? Hgb, Hct, platelets
What is the treatment for acute bleeding from anticoagulants? FFP, packed RBCs
What is the black box warning for all anticoagulants? neuraxial anesthesia (hematomas)
What is the MOA of warfarin? inhibits production of several vitamin K dependent clotting factors
Which clotting factor has a half life of 4-6 hours? VII
Which clotting factor has a half life of 8-10 hours? Protein C
Which clotting factor has a half life of 20-30 hours? IX
Which clotting factor has a half life of 24-40 hours? X
Which clotting factor has a half life of 40-60 hours? Protein S
Which clotting factor has a half life of 60-100 hours? II
What is protime? the time in seconds for a clot to form
What is the reliability of the result influenced by? sensitivity of thromboplastin reagents
What is the equation for INR? (PT patient/PT control)^ISI
How do you first monitor INR? twice a week
How do you monitor INR after a dose change? in 7-14 days
When is warfarin CI? active or recent major bleed, alcohol/drug abuse, pregnancy, patient at risk for trauma or falls
When does purple toe syndrome typically occur? 3-10 weeks after starting warfarin
What is the cause of warfarin induced skin necrosis? deficiency in protein C or S
What should be given to patients with warfarin induced skin necrosis? heparin
Which warfarin enantiomer is 4x more potent? S (9/19)
If there is a transient drug interaction how do you change warfarin dose? skip 1-2 doses
How does diarrhea effect INR? increases
Which medication is most likely to increase a patient's INR? metronidazole
Which OTC pain reliever is safest to take with warfarin? APAP
How do grapefruit and cranberry juices effect INR? increase
How does chronic alcohol effect INR? decreases (binge drinking increases INR)
What does smoking while on warfarin do? induce 1A2 (metabolism of R-isomer)
Created by: jgk25