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In patients with cancer with VTE, what is the preferred pharmacological treatment?
oral Xa inhibitor/DOAC
What are the two types of assay utilized in HIT?
immunoassay and functional assay
In VTE treatment, how long must a parenteral agent be on board before transitioning to dabigatran?
5 days
When is VTE reoccurrence most common?
First 3 months
If the patient's INR goal is 2.5 to 3.5, and INR results less than 2 with reported compliance and no changes in diet, how would you adjust their warfarin?
Give additional dose and increase weekly dose by 10% to 20%
If the patient's INR goal is 2 to 3 and their INR results 3.8 with reported compliance and no change in diet, how would you adjust the dose?
Withhold no dose to one dose --> Decrease weekly dose by 10% to 15%
What population would a higher initial dosing of warfarin be warranted?
young and healthy
What population would a lower starting dose of warfarin be warranted?
frail, elderly, malnourished, liver/kidney disease, heart failure, or acute illness
At what doses of rivaroxaban should a patient be counseled to take with food?
15 mg or greater
What is the monitoring parameter for a heparin drip?
anti-Xa or aPTT
How are argatroban and bivalirudin monitored in HIT?
aPTT
What is the INR goal if the patient has a prosthetic mechanical mitral valve?
2.5 to 3.5
In afib, what are the 3 criteria for dose reduction for apixaban?
age 80 or greater, weight 60 kg or less, or SCr 1.5 mg/dL or greater
What are the two types of pathways in the coagulation cascade?
intrinsic and extrinsic pathways
What are the two classifications of venous thromboembolism?
DVT and PE
What CYP enzyme are apixaban and rivaroxaban metabolized by?
CYP3A4
All DOACs are a substrate of ______
P-glycoprotein
What agents are non-heparin anticoagulants for HIT?
argatroban, bivalirudin, fondaparinux, and DOAC (apixaban or rivaroxaban but are off label use), warfarin
What are the two types of HIT? Which one is clinically important?
Type I and II; Important: Type II
In HIT, what complex does the antibody recognize?
complex of PF4 and heparin
What are the 4Ts for HIT?
degree of thrombocytopenia, timing of platelet count, thrombosis of other sequelae, and other causes of thrombocytopenia
What is the scoring tool in stroke prevention in afib to assess risk of major bleeding for patients on anticoagulation/
HAS-BLED
In stroke prevention in afib, when would warfarin be indicated over a DOAC?
valvular afib (defined as moderate to severe mitral stenosis or mechanical heart valve)
What is CHADSVASc and the associated scores for each risk factor?
*see picture*
What criteria screening tool is used for DVT and PE?
Wells'
Which DOAC is recommended if CrCl < 15 mL/min?
apixaban
Which DOAC is contraindication if CrCl >95 mL/min?
edoxaban
What are the 3 guidelines used for anticoagulation?
CHEST, NICE, ASH
What is the scoring tool for VTE prophylaxis?
Padua
What is Virchow's triad?
hypercoagulability, stasis, and endothelial injury
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