Anticoagulant and Antiplatelet Therapy Guidelines
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Questions and Answers

What is the primary consideration when deciding between anticoagulant and/or antiplatelet therapy for certain conditions?

  • Analysis of the risk of thrombosis vs bleeding risk (correct)
  • Type of condition being treated
  • Availability of medication
  • Patient's medical history

    • Which of the following anticoagulants has the highest bleeding risk?

  • Antiplatelets
  • Fibrinolytics (correct)
  • Anticoagulants
  • Fondaparinux

    • What is the mechanism of action of unfractionated heparin (UFH)?

  • UFH binds with antithrombin III, enhancing its activity (correct)
  • UFH reduces platelet aggregation by inhibiting thrombin's actions
  • UFH directly inhibits thrombin and factor Xa
  • UFH inhibits only factor Xa

    • Which of the following is NOT a commonly used oral anticoagulant?

    <p>Edoxaban</p> Signup and view all the answers

    What is the difference in the mechanism of action of UFH and LMWHs?

    <p>UFH requires a larger molecule to inhibit thrombin, while LMWHs are more selective inhibitors of factor Xa</p> Signup and view all the answers

    What is the source of heparin used as medication?

    <p>Porcine or bovine intestine</p> Signup and view all the answers

    What is the primary target of fondaparinux?

    <p>Factor Xa</p> Signup and view all the answers

    Why is the anticoagulant effect of a fixed dose of heparin variable?

    <p>Due to individual differences in plasma concentration of neutralizing plasma proteins</p> Signup and view all the answers

    What is a possible cause of heparin resistance?

    <p>High concentrations of heparin binding proteins in plasma</p> Signup and view all the answers

    What is the major difference between LMWHs and fondaparinux?

    <p>Fondaparinux has a higher specificity to factor Xa</p> Signup and view all the answers

    What is the effect of high doses of heparin on platelet aggregation?

    <p>Decrease platelet aggregation</p> Signup and view all the answers

    What is the mode of action of heparin in vitro?

    <p>By inhibiting clotting</p> Signup and view all the answers

    What is the primary requirement for heparin to form a complex in order to inactivate clotting factors?

    <p>Antithrombin III</p> Signup and view all the answers

    What is the therapeutic use of heparin in acute coronary syndromes?

    <p>Treatment of acute MI</p> Signup and view all the answers

    What is the characteristic of fondaparinux that allows for once daily or BID dosing?

    <p>Greater predictability of AC and PK</p> Signup and view all the answers

    What is the common adverse effect of long-term use of heparin?

    <p>Osteoporosis</p> Signup and view all the answers

    What is the route of administration for fondaparinux?

    <p>SC</p> Signup and view all the answers

    What is the reversal agent for heparin and LMWHs?

    <p>Protamine sulfate</p> Signup and view all the answers

    What is a contraindication for the use of DOACs?

    <p>Patients with mechanical heart valves or moderate to severe mitral stenosis</p> Signup and view all the answers

    Which of the following DOACs does not require parenteral anticoagulation prior to initiation for VTE treatment?

    <p>Apixaban</p> Signup and view all the answers

    What is an advantage of DOACs compared to warfarin?

    <p>Fewer dietary interactions</p> Signup and view all the answers

    What is the therapeutic use of DOACs in patients with non-valvular atrial fibrillation?

    <p>Prevention of thromboembolism</p> Signup and view all the answers

    Which of the following is a potential complication of using DOACs with neuraxial anesthesia or spinal puncture?

    <p>Epidural or spinal hematomas</p> Signup and view all the answers

    What is the advantage of DOACs in terms of dosing compared to warfarin?

    <p>Fixed dosing</p> Signup and view all the answers

    What is the primary indication for using four-factor prothrombin complex concentrate?

    <p>Life-threatening hemorrhage associated with vitamin K antagonist</p> Signup and view all the answers

    What is the advantage of fibrinogen concentrate over cryoprecipitate?

    <p>More specific for congenital fibrinogen deficiency</p> Signup and view all the answers

    What is the mechanism of action of desmopressin in von Willebrand disease?

    <p>Stimulates the release of endogenous VWF from storage sites</p> Signup and view all the answers

    What is the indication for using von Willebrand factor concentrate?

    <p>Von Willebrand disease</p> Signup and view all the answers

    What is the role of tranexamic acid or epsilon aminocaproic acid in bleeding management?

    <p>To inhibit fibrinolysis</p> Signup and view all the answers

    What is the contraindication for using four-factor prothrombin complex concentrate?

    <p>History of HIT</p> Signup and view all the answers

    What is the primary consideration when deciding between anticoagulant and/or antiplatelet therapy for certain conditions?

    <p>Evidence-based guidelines, patient factors, medication factors, and an analysis of the risk of thrombosis vs bleeding risk</p> Signup and view all the answers

    What is the order of bleeding risk from highest to lowest?

    <p>Fibrinolytics &gt; anticoagulants &gt; antiplatelets</p> Signup and view all the answers

    What is the mechanism of action of LMWHs?

    <p>Inhibiting only factor Xa</p> Signup and view all the answers

    Which of the following anticoagulants is used for HIT treatment or for VTE treatment/prophylaxis in patients with a history of HIT?

    <p>Fondaparinux</p> Signup and view all the answers

    What is the source of heparin used as medication?

    <p>Porcine or bovine intestine</p> Signup and view all the answers

    Which of the following oral anticoagulants is not commonly used?

    <p>Edoxaban</p> Signup and view all the answers

    What is the main reason why venous stasis can lead to thrombus formation?

    <p>Activated coagulation factors are not diluted by normal blood flow</p> Signup and view all the answers

    Which type of thrombi are typically treated with drugs that alter platelet function?

    <p>Arterial thrombi</p> Signup and view all the answers

    What is the primary use of fibrinolytic agents in thrombotic disorders?

    <p>Rapid dissolution of thromboemboli in emergency situations</p> Signup and view all the answers

    What is the typical duration of therapeutic anticoagulation with a parenteral anticoagulant?

    <p>Short-term, often transitioned to longer-term anticoagulation with an oral agent</p> Signup and view all the answers

    What is the purpose of using anticoagulants and antiplatelet agents in combination in some patients?

    <p>To enhance the anticoagulant effect of each individual agent</p> Signup and view all the answers

    In which patients may antiplatelet agents be used as an alternative to anticoagulants for VTE prevention?

    <p>Patients undergoing orthopedic surgery</p> Signup and view all the answers

    What is the primary reason for dose adjustment in renal impairment when using warfarin?

    <p>Increased risk of bleeding</p> Signup and view all the answers

    Which of the following medications is likely to decrease the anticoagulant effect of warfarin?

    <p>Carbamazepine</p> Signup and view all the answers

    What is the recommended approach to vitamin K intake when taking warfarin?

    <p>Maintain consistent vitamin K intake</p> Signup and view all the answers

    Which of the following patient factors can affect the efficacy of warfarin?

    <p>All of the above</p> Signup and view all the answers

    What is a rare but serious adverse effect of warfarin?

    <p>Skin and tissue necrosis</p> Signup and view all the answers

    Which of the following medications can increase the risk of bleeding when used concomitantly with warfarin?

    <p>NSAIDs</p> Signup and view all the answers

    What is the primary indication for using four-factor prothrombin complex concentrate?

    <p>Life-threatening hemorrhage associated with vitamin K antagonists</p> Signup and view all the answers

    What is the advantage of fibrinogen concentrate over cryoprecipitate?

    <p>It is more specific for congenital fibrinogen deficiency</p> Signup and view all the answers

    What is the effect of desmopressin in von Willebrand disease?

    <p>It releases endogenous VWF from storage sites in endothelial cells</p> Signup and view all the answers

    What is the contraindication for using four-factor prothrombin complex concentrate?

    <p>History of HIT</p> Signup and view all the answers

    What is the role of tranexamic acid or epsilon aminocaproic acid in bleeding management?

    <p>They prevent fibrinolysis of clot</p> Signup and view all the answers

    What is the composition of cryoprecipitate?

    <p>Fibrinogen, factor VIII, XIII, VWF, fibronectin</p> Signup and view all the answers

    What is the primary mechanism of action of emicizumab in hemostasis?

    <p>It binds to factor IXa and X, substituting for the role of factor VIII</p> Signup and view all the answers

    What is the indication for using NovoSeven RT?

    <p>Bleeding in hemophilia patients with inhibitors</p> Signup and view all the answers

    What is the role of desmopressin in hemophilia patients?

    <p>It increases the plasma levels of von Willebrand factor and factor VIII</p> Signup and view all the answers

    What is the composition of prothrombin complex concentrates (PCCs)?

    <p>They contain factor IX among others</p> Signup and view all the answers

    What is the limitation of using factor replacement therapy in hemophilia patients?

    <p>It is not effective in patients with inhibitors</p> Signup and view all the answers

    What is the half-life of emicizumab?

    <p>4-5 weeks</p> Signup and view all the answers

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