PHRM538---VTE Treatment

If there is a high risk of acute VTE while waiting for diagnostic test results, what should be done?

Begin treatment with parenteral anticoagulants immediately while waiting

If there is intermediate risk of acute VTE while waiting for diagnostic test results, what should be done?

Begin treatment with parenteral anticoagulant if wait will be longer than 4 hours

If there is low risk of acute VTE while waiting for diagnostic tests, what should be done?

Begin treatment with parenteral anticoagulant if wait will be longer than 24 hours

What are the preferred anticoagulants for treatment of DVT or PE?

Dabigatran, rivaroxaban, apixaban or edoxaban over warfarin

What is the preferred anticoagulants for treatment of DVT or PE in cancer patients?

DOACs > LMWH > Warfarin

What anticoagulant should be used to treat DVT or PE in a patient with antiphospholipid syndrome?

Warfarin

How should left ventricular thrombus be treated?

Warfarin for 3 months and then re evaluate

What is the duration of treatment of provoked DVT or PE?

3 months

What is the duration of treatment of unprovoked DVT or PE?

3 months and then re evaluate

What is recommended when stopping anticoagulation after an unprovoked DVT or PE?

ASA

Acute alcohol intake has what effect on INR?

Increase

Chronic alcohol intake has what effect on INR?

Decrease

What are the signs or symptoms of stroke?

BEFAST (balance, eye changes, facial droop, arm weakness, slurred speech, time to call 911)

What is the typical initial warfarin regimen?

5-10 mg daily for 2 days and check INR

What dosing change is typically used when adjusting warfarin dosing?

5-20% dose change of weekly dose

What should be done if INR is 4.5 to 10 with no bleeding?

Lower weekly dose and consider holding a dose

What should be done if INR is greater than 10 and no bleeding?

Administer oral vitamin K

What should be done if a patient on warfarin is bleeding?

Vitamin K IV and 4F-PCC

What are some common things that increase INR?

Metronidazole, erythromycin, bactrim, amiodarone, tetracyclines, SSRI, statins, macrolides, gingko biloba, APAP >2 grams, vitamin E

What are common things that decrease INR?

Carbamazepine, phenytoin, rifampin, ginseng, green tea

What common thing might increase or decrease INR?

Corticosteroids

What are some common things that increase risk of bleeding without changing INR?

ASA, clopidogrel, NSAIDs, or LMWH

When should warfarin be stopped before surgery?

5 days before

What should be used to bridge therapy when not on warfarin before surgery?

LMWH or UFH

When should warfarin be restarted after surgery?

12-24 hours