Cardiovascular Revision - Part 1
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Questions and Answers

Which condition requires a reduction in dose due to high bleeding risk?

  • Patient under 50 years with no medical history
  • Patient on Verapamil (correct)
  • Patient aged 75 years (correct)
  • Patient with CrCl of 20 ml/min (correct)

    • What is a characteristic symptom of ischaemic stroke?

  • Severe headache
  • Nausea and vomiting
  • Chest pain
  • Face dropping (correct)

    • Which statement is accurate regarding antiplatelets in ischaemic stroke?

  • They decrease platelet aggregation (correct)
  • They are the first line for all strokes
  • They increase thrombus formation
  • They are prescribed for primary prevention of cardiovascular disease

    • What should be avoided in patients with an intracerebral haemorrhagic stroke?

    <p>Using anticoagulants</p> Signup and view all the answers

    What is the recommended management for a patient with intracerebral haemorrhagic stroke?

    <p>Lower cholesterol with a statin</p> Signup and view all the answers

    Which of the following is NOT a licensed oral anticoagulant in the UK?

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

    What is a common symptom associated with both Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)?

    <p>Pain and swelling in the leg</p> Signup and view all the answers

    Which factor does NOT influence thrombus formation?

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

    What is the preferred pharmacological treatment for VTE during pregnancy?

    <p>Low molecular weight heparin (LMWH)</p> Signup and view all the answers

    Which of the following conditions is considered a predisposing risk factor for Venous Thromboembolism (VTE)?

    <p>Family history</p> Signup and view all the answers

    Which of the following treatments is NOT a recommended approach for VTE prophylaxis?

    <p>Oral iron supplements</p> Signup and view all the answers

    What is the duration of prophylaxis treatment for patients undergoing major cancer surgery in the abdomen or pelvis?

    <p>28 days</p> Signup and view all the answers

    Which of the following statements about Fondaparinux is accurate?

    <p>It inhibits activated factor X.</p> Signup and view all the answers

    What is the primary action of Low Molecular Weight Heparin (LMWH)?

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

    Which condition significantly increases the risk of hyperkalaemia when using Heparins?

    <p>Diabetes and kidney disease</p> Signup and view all the answers

    When should treatment with Heparin be stopped during pregnancy?

    <p>When the patient goes into labour</p> Signup and view all the answers

    What is the recommended method for monitoring a patient's response to Unfractionated Heparin?

    <p>Activated partial thromboplastin time (APTT)</p> Signup and view all the answers

    What is a serious side effect associated with both LMWH and Unfractionated Heparin?

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

    For how long is Warfarin treatment generally recommended for provoked VTE caused by surgery?

    <p>3 months</p> Signup and view all the answers

    Which of the following is the primary use of Protamine sulphate?

    <p>To reverse Heparin effects</p> Signup and view all the answers

    Which of the following Heparins has a lower risk of osteoporosis and heparin-induced thrombocytopenia (HIT)?

    <p>Low Molecular Weight Heparin (LMWH)</p> Signup and view all the answers

    Why should Warfarin be avoided during pregnancy?

    <p>It is teratogenic and increases the risk of congenital malformations.</p> Signup and view all the answers

    What is the primary purpose of the yellow treatment book/anticoagulant alert card?

    <p>To record current INR levels and current medication dose.</p> Signup and view all the answers

    What should a patient do if they exhibit signs of bleeding while on Warfarin?

    <p>Immediately stop taking Warfarin and seek medical attention.</p> Signup and view all the answers

    Under what circumstances should Warfarin be stopped?

    <p>If calciphylaxis is diagnosed.</p> Signup and view all the answers

    What dosage of Warfarin is recommended if rapid anticoagulation is needed?

    <p>5mg once daily for 2 days and reassess.</p> Signup and view all the answers

    What is the target INR for patients with mechanical prosthetic heart valves?

    <p>3.0 - 3.5</p> Signup and view all the answers

    What is the recommended frequency for monitoring INR after stabilization?

    <p>Every 3 months.</p> Signup and view all the answers

    Which of the following substances can interact with Warfarin and increase INR?

    <p>OTC oral miconazole gel.</p> Signup and view all the answers

    What is the recommended action for a patient experiencing major bleeding while on Warfarin?

    <p>Stop Warfarin and administer IV Phytomenadione.</p> Signup and view all the answers

    Which of the following medications is classified as a direct thrombin inhibitor?

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

    In which scenario should NOACs be avoided?

    <p>Patient with CrCl &lt; 15 ml/min.</p> Signup and view all the answers

    What is a significant advantage of using NOACs over traditional anticoagulants like Warfarin?

    <p>Fixed dosing without adjustments.</p> Signup and view all the answers

    When should the dose of Apixaban be reduced?

    <p>If Cr is greater than 133 micromol/L and age is 80 or older.</p> Signup and view all the answers

    What is the initial action for a patient with INR greater than 8.0 but without bleeding?

    <p>Stop Warfarin and give IV Phytomenadione orally.</p> Signup and view all the answers

    Which of the following factors increases bleeding risk when using NOACs?

    <p>Concomitant use of SSRIs.</p> Signup and view all the answers

    How should Rivaroxaban be administered for optimal absorption?

    <p>With food or directly after a meal.</p> Signup and view all the answers

    Study Notes

    Cardiovascular Revision - Part 1

    • Five oral anticoagulants licensed in the UK include Warfarin, Apixaban, Edoxaban, Rivaroxaban, and Dabigatran.
    • Deep vein thrombosis (DVT) is a blood clot forming in a deep vein, often in the leg.
    • Pulmonary embolism (PE) occurs when a blood clot travels to the lung, blocking blood flow.
    • Symptoms of DVT/PE include pain, swelling, tenderness, changes in skin colour/temperature, and vein distension.

    Predisposing Risk Factors for Venous Thromboembolism (VTE)

    • Age
    • Obesity
    • Family history
    • Concurrent medical conditions
    • Medications like hormone replacement therapy (HRT) or contraceptives with oestrogen.
    • Pregnancy

    VTE Risk Assessment

    • Malignant diseases
    • Varicose veins and phlebitis (inflammation of a vein near the skin's surface)
    • Critical care admission
    • Significant co-morbidities

    Factors Influencing Thrombus Formation

    • Blood flow abnormalities (e.g., atrial fibrillation)
    • Blood vessel surfaces (e.g., mechanical heart valves)
    • Clotting component deficiencies (e.g., Factor V Leiden, protein C, and protein S)

    VTE Prevention and Treatment

    • Mechanical Treatment: Anti-embolic stockings
    • Pharmacological Treatment:
    • Parenteral: Low molecular weight heparin (LMWH), fondaparinux, unfractionated heparin (use in severe renal impairment or renal failure)
    • Oral: NOACs (e.g., Rivaroxaban)
    • Duration of Prophylaxis:
    • General surgery: 5-7 days or until sufficient mobility
    • Major cancer surgery (abdomen/pelvis): 28 days
    • Knee/hip surgery: Extended duration

    Duration of VTE Treatment

    • Major cancer surgery in abdomen or pelvis: 28 days
    • General surgery: 5-7 or until sufficient mobility
    • Knee/hip surgery: Extended duration

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    Cardiovascular Revision Part 1.1

    Description

    This quiz covers key aspects of cardiovascular health, focusing on oral anticoagulants, deep vein thrombosis (DVT), and pulmonary embolism (PE). Test your knowledge on the symptoms, risk factors, and assessment for venous thromboembolism (VTE). Understand the influences on thrombus formation for better clinical insight.

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