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29 Cards in this Set

  • Front
  • Back
What coagulation pathway is involved in venous thrombosis?
intrinsic pathway
What is virchows triad?
hypercoagulable state

endothelial injury

circulatory stasis
What is Heparin's MOA?
binds to antithrombin III (activating it)
What is the prophylaxis dose of heparin?
5,000 units SC BID or TID
What is the treatment dose of heparin?
80 units/kg IV bolus
(18 units/kg/hr)
What is the target aPTT when on heparin therapy?
1.5-2.5 X baseline
During heparin therapy how often should aPTT be checked until therapeutic level is achieved?
every 6 hrs
What are the LMWH?
Enoxaparin
Dalteparin
What is the prophylaxis dose of enoxaparin?
30-40 mg SC daily
What is the treatment dose of enoxaparin with normal renal function?
1 mg/kg SC every 12 hrs
What is the treatment dose of enoxaparin for renal dysfunction (CrCl <30 ml/min)?
1 mg/kg SC every 24 hrs
What is the treatment dose of enoxaparin for obese patients?
1 mg/kg SC every 12 hrs
(max of 150 mg SC every 12 hrs)
How is LMWH easier to use than heparin?
-can be given SC for treatment rather than IV
-longer duration of action
-less thrombocytopenia
-more predictable therapeutic effect
-does not require blood test monitoring
What is the factor Xa inhibitor drug?
Fondaparinux
What drug is used in patients with a hx of heparin induced thrombocytopenia?
fondaparinux
How does warfarin work?
inhibits Vit K clotting factors (2,7,9,10)
Warfarin interacts significantly with what other drugs?
antibiotics
antiplatelets
NSAIDs
A large loading dose of what medication may cause hemorrhagic complications?
warfarin
What is the starting dose of warfarin?
5 mg daily
What is the therapeutic INR for VTE?
2-3 (normally 1)
How long should warfarin therapy be continued?
first episode: 3-6 months
second or more episode: lifelong therapy
What is the goal INR in a patient with a mechanical heart valve?
2.5-3.5
When is Vit K administered for over-anticoagulation?
INR >9
unless active bleeding

(give 2.5 mg PO or 1 mg IV)
When can bridging therapy be d/c?
when therapeutic INR is achieved for 2-3 consecutive days (or at least 5 days)
What patients need bridging?
High risk: recent VTE (within 3 months), severe thrombophilia

Moderate risk: VTE withing 3-12 months, non severe thrombophilic conditions, recurrent VTE, active cancer
What patient does NOT need bridging?
low risk: single VTE occurred > 12 months ago and no other risk factors
When do you stop warfarin therapy before a procedure?
5 days before procedure
When do you stop IV UFH or IV LMWH before a procedure?
UFH: 6 hrs before
LMWH: 24 hrs before
When do you resume warfarin therapy after a procedure?
High/mod risk: 12-24 hrs after
Low risk: 12-48 hrs after

(resume at usual dose)