This is Why We Clot
The preferred anticoagulant class for the treatment of acute DVT/PE, per the 2021 CHEST VTE Guidelines
Direct Oral Anticoagulants
The least renally
eliminated DOAC
Apixaban
The Risk Stratification “4T Score” stands for: acute Thrombocytopenia, Timing of Thrombocytopenia, Thrombosis, and _______
oTher Causes
Typical Vitamin K dosing for warfarin reversal ranges from 1-5 milligrams
The recommended dietary allowance of vitamin K is 90-120 _____ (units of measurement) per day
90-120 micrograms
The appropriate practice for transitioning a patient from IV heparin to apixaban or rivaroxaban
Simultaneously stop heparin and start apixaban/rivaroxaban
The reduced dose (mg) and dosing frequency of rivaroxaban endorsed by the 2021 VTE CHEST guidelines for extended-phase anticoagulation (following 3-6 months of treatment)
Rivaroxaban 10 mg daily
The only anticoagulant/drug class that works on reducing clotting factor production
Warfarin
In the absence of recent heparin exposure in the past 3 months, the typical onset of thrombocytopenia following heparin initiation (day range)
5-10 days
Administered in combination with KCENTRA (4-Factor Prothrombin Complex Concentrate) for patients with a major bleed secondary to warfarin
Vitamin K (intravenous)
This medication, commonly used for patients with alcohol withdrawal, will negate the effects of apixaban & rivaroxaban – though it may take about a week to do so
Phenobarbital
The preferred long-term anticoagulant for the treatment of VTE associated with Antiphospholipid Antibody Syndrome
Warfarin
This anticoagulant has minimal anticoagulant activity by itself, but potentiates the effects of anti-thrombin 3 to inactivate factors IIa, IXa, Xa, XIa, and XIIa
Unfractionated Heparin
The only subcutaneous anticoagulant safe to use in a patient with acute HIT(T)
Fondaparinux
Approximate time in hours (range acceptable) following the administration of IV Vitamin K to observe full INR lowering effect
12-24 hours
In the absence of bleeding, the recommended minimum number of days of parenteral bridge anticoagulation therapy for patients newly initiated on warfarin for an acute DVT/PE
5 Days
According to the 2021 CHEST Guidelines for VTE, the preferred drug class for the treatment of cancer-associated VTE
Factor Xa Inhibitors
(apixaban, edoxaban, rivaroxaban)
In patients with non-valvular atrial fibrillation, the only DOAC not associated with an increased risk of GI bleeding compared to warfarin
Apixaban
Avoid this type of transfusion in a patient with suspected or confirmed HIT(T)
Platelets
Recommended hold time for DOACs prior to a major (bleed risk) surgery, in the absence of renal dysfunction
48 hours
Following Watchman Device Placement in patients with atrial fibrillation, the recommended antithrombotic regimen immediately post placement (45 days)
Oral Anticoagulant + Aspirin 81 mg daily
The 3 components of Virchow’s triad, developed by German scientist Rudolf Virchow to describe factors that increase the risk for venous thrombosis
1. Stasis
2. Hypercoagulable state
3. Vessel wall injury
The only drug class with the ability to break down/dissolve blood clots
Thrombolytics
Examples: alteplase, tenecteplase
This non-heparin anticoagulant should be avoided in the setting of acute HIT(T) while a patient remains thrombocytopenic
Warfarin
According to the 2018 ASH Guidelines for Management of VTE, at what INR threshold (above what INR value) should Vitamin K be considered for warfarin reversal in the absence of:
-Major or minor bleeding
-High risk for bleeding
-Upcoming procedure/surgery
INR >10
Two genetic thrombophilic disorders that can be tested for irrespective of concomitant anticoagulation or acute thrombosis
•Factor V Leiden
–Mutation on Factor V, preventing Protein C from inactivating it
•Prothrombin Gene Mutation
–Excessive prothrombin à excessive thrombin