Anticoagulation Reversal, HIT, and Peripheral Arterial Disease Review

Comprehensive practice questions covering anticoagulation reversal agents, high INR management, the distinction between HIT and HAT, and the diagnosis and classification of Peripheral Arterial Disease.

When should anticoagulants be reversed?

Major bleeding or prevent future bleeding

What type of reversal agent replaces clotting factors, reverses warfarin’s effects?

Fresh frozen plasma

What type of reversal agent activates extrinsic clotting pathway, mostly for warfarin?

Recombinant factor VIIa

What type of reversal agent concentrated formulation of clotting factors, mostly for warfarin but also factor Xa inhibitors?

prothrombin complex concentrates

What type of reversal agent reverses warfarin?

Vitamin K

What type of reversal agent reverses UFH > enoxaparin?

Protamine sulfate

What type of reversal agent reverses dabigatran?

Idarucizumab (Praxbind)

What should be done if INR is above therapeutic but < 4.5?

Lower dose, monitor more frequently

What should be done if INR is > 4.5 but < 10?

Omit 1-2 doses, monitor more requently, administer new adjusted dose once INR is therapeutic

What should be done if INR is > 10?

Hold warfarin & administer 2.5-5 mg of oral vitamin K, monitor more frequently

What dose of vitamin K should be given if INR is > 10?

2.5-5 mg

What should be done if there is life-threatening bleeding?

Hold warfarin & administer vitamin K 5-10 mg by IV & administer FFP, rVIIa, or PCC

What dose of vitamin K should be given if there is life-threatening bleeding?

5-10 mg

Which agent is used to reverse Dabigatran?

Idarucizumab (Praxbind)

Which reversal agent is most effective for Unfractionated Heparin (UFH)?

Protamine sulfate

What is it called when platelet count < 150,000?

Thrombocytopenia

What can 10-20%. of patients on heparin get?

Heparin associated thrombocytopenia

What is the onset of Heparin associated thrombocytopenia?

1-4 days

Can patients continue heparin when they have Heparin associated thrombocytopenia?

Yes

What can 1-3%. of patients on heparin get?

Heparin induced thrombocytopenia

What is the onset for Heparin induced thrombocytopenia?

5-14 days

Is Heparin induced thrombocytopenia antibody mediated?

Yes

Is Heparin associated thrombocytopenia antibody mediated?

No

Does Heparin induced thrombocytopenia lead to thrombosis?

Yes

Does Heparin associated thrombocytopenia lead to thrombosis?

No

What are the components of the 4Ts score for HIT probability?

Thrombocytopenia, Timing of platelet drop, Thrombosis, and oTher causes of thrombocytopenia.

What happens to a patients platelets when Heparin induced thrombocytopenia happens?

Low

What must be decreased when a person has Heparin induced thrombocytopenia?

heparin

What happens if a person develops Heparin induced thrombocytopenia?

Heparin should be avoided

What is the common form of peripheral vascular disease?

Peripheral arterial disease

What does peripheral arterial disease restrict blood circulation to?

Kidneys, stomach, arms, legs, feet

What are risk factors to PAD?

Diabetes, age, smoking, hypertension, hyperlipidemia

What is the clinical presentation for early stages in PAD?

Asymptomatic

What is the clinical presentation for later stages in PAD?

Paid & discomfort

What is the 2 common characteristics of PAD?

Intermittent claudication & pain at rest in lower extremities

What is Pain and cramping in the legs during physical activity, typically caused by reduced blood flow due to narrowed arteries called?

Intermittent claudication

What is ankle brachial index used to diagnosis?

Asymptomatic disease

How is ABI calculated?

Ankle pressures/brachial pressures

What is a normal ABI?

> 0.9

What is mild ABI?

0.7-0.9

What is moderate ABI?

0.4-0.7

What is severe ABI?

≤ 0.4