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What are the drug-related risk factors for developing a clot?
estrogen-type drugs (OC, HRT, SERMs)
What parameter is monitored for heparin?
aPTT = 25-35 seconds
What parameter is monitored for LMWH?
anti-Xa = 0.5-1.0 U/ml (BID), 1-2 U/ml (QD)
What is monitored for lepirudin and argatroban?
What parameters are monitored for warfarin?
INR (usually 2-3)
How much vitamin K should be given to a pt who's INR is 3-5?
How much vitamin K should be given to a pt who's INR is 6-9?
1-2.5 mg PO
How much vitamin K should be given to a pt who's INR is 10-20?
3-5 mg PO
How much vitamin K should be given to a pt who's INR is > 20 or who is seriously bleeding?
10 mg IV
What drugs have a significant interaction with warfarin?
How do you treat a pregnant woman who needs anticoagulation?
How do you treat a woman who is breastfeeding and needs anticoagulation?
What is heparin-induced thrombocytopenia?
a serious allergic reaction to heparin
reduction in platelet count
usually occurs 5-14d into tx
can cause a clot
How do you treat HIT?
use lipirudin or argatroban, or fondaparinux
avoid inital use of warfarin d/t risk of venous limb gangrene
What is the recommended duration of warfarin tx for VTE with reversible risk factor present?
What is the recommended duration of warfarin tx for VTE that is idiopathic?
at least 12 mo
What is the recommended duration of warfarin tx for acute unstable a-fib with cardioversion?
3 wks before til 4 wks after cardioversion
What is the duration of warfarin tx for prevention of recurrent DVT/PE, thrombosis in chronic a-fib, or thrombosis in prosthetic heart valves?
What is the recommended plan for heparin prophylaxis?
5000 units SQ q 8-12h for at least 5 days and INR is therapeutic for 24h
What is the recommended plan for LMWH prophylaxis?
40mg SQ qd for at least 5 days and INR therapeutic for 24h
What is the recommended plan for LMWH tx?
1 mg/kg SQ bid at least 5d and INR therapeutic for 24h