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 (A)</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 (C)</p> Signup and view all the answers

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

    <p>Heparin (D)</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 (C)</p> Signup and view all the answers

    Which factor does NOT influence thrombus formation?

    <p>Age (B)</p> Signup and view all the answers

    What is the preferred pharmacological treatment for VTE during pregnancy?

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

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

    <p>Oral iron supplements (B)</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 (D)</p> Signup and view all the answers

    Which of the following statements about Fondaparinux is accurate?

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

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

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

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

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

    When should treatment with Heparin be stopped during pregnancy?

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

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

    <p>Haemorrhage (B)</p> Signup and view all the answers

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

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

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

    <p>To reverse Heparin effects (C)</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) (B)</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. (C)</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. (B)</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. (B)</p> Signup and view all the answers

    Under what circumstances should Warfarin be stopped?

    <p>If calciphylaxis is diagnosed. (D)</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. (A)</p> Signup and view all the answers

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

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

    What is the recommended frequency for monitoring INR after stabilization?

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

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

    <p>OTC oral miconazole gel. (D)</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. (B)</p> Signup and view all the answers

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

    <p>Dabigatran (C)</p> Signup and view all the answers

    In which scenario should NOACs be avoided?

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

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

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

    How should Rivaroxaban be administered for optimal absorption?

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

    Flashcards

    What is Deep Vein Thrombosis (DVT)?

    A blood clot that forms within a deep vein, usually in the leg.

    What is a Pulmonary Embolism (PE)?

    A blood clot that travels to the lungs and blocks blood flow to a part of the lung.

    What are predisposing risk factors for VTE?

    Factors that increase the likelihood of developing a blood clot, such as age, obesity, family history, certain medical conditions, and specific medications.

    What is Factor V Leiden?

    A mutation in one of the clotting factors in blood, leading to an increased risk of blood clot formation.

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    What are NOACs (Novel Oral Anticoagulants)?

    A type of anticoagulant (blood thinner) that helps prevent blood clots. Examples include Rivaroxaban and Apixaban.

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    What are Oral Anticoagulants?

    A type of anticoagulant (blood thinner) used to prevent or treat blood clots. Examples include Warfarin, Dabigatran, and Rivaroxaban.

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    What is Fondaparinux?

    A type of drug that prevents blood clot formation by blocking activated Factor X.

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    Why is LMWH preferred for treating VTE during pregnancy?

    A type of medication used to prevent blood clots during pregnancy. It does not cross the placenta and is generally considered safer than other anticoagulants for mothers and babies.

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    What are heparins and how are they administered?

    Heparins are a type of anticoagulant that prevents blood clots by inhibiting coagulation factors. They are administered intravenously or subcutaneously. There are two main types: unfractionated heparin and low-molecular-weight heparin (LMWH).

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    How does pregnancy affect LMWH treatment?

    LMWHs are readily eliminated during pregnancy, requiring frequent dose adjustments. It is crucial to discontinue treatment once labor begins. If further anticoagulation is necessary, consult a specialist.

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    What is a significant side effect of heparin therapy?

    One major adverse effect of heparin treatment is hyperkalaemia. This occurs due to the inhibition of aldosterone secretion, which normally helps regulate potassium levels. Patients with kidney disease or diabetes are at higher risk due to reduced potassium excretion. Regular monitoring of potassium levels is essential.

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    What are the key features of LMWHs?

    LMWHs, such as tinzaparin, enoxaparin, and dalteparin, exert their effect by inhibiting factor Xa. They possess a longer duration of action compared to unfractionated heparin, leading to a reduced risk of osteoporosis and heparin-induced thrombocytopenia (HIT).

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    How does unfractionated heparin work and when is it preferred?

    Unfractionated heparin acts by activating antithrombin, a naturally occurring protein that inhibits coagulation factors. It has a shorter duration of action than LMWH and is preferred in patients with a high bleeding risk or renal impairment. Its effectiveness is assessed by monitoring the activated partial thromboplastin time (APTT).

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    What is the antidote for heparin overdose?

    Protamine sulfate can be administered to partially reverse the effects of heparin therapy. It binds to heparin, forming a stable complex that lacks anticoagulant activity.

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    What is warfarin and how does it work?

    Warfarin is an oral anticoagulant that works by inhibiting vitamin K synthesis, which is essential for blood clotting. It takes 2-3 days to become effective, and it is often used in conjunction with heparin for immediate anticoagulation.

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    How long does warfarin treatment usually last?

    Warfarin treatment duration depends on the specific situation. For isolated calf deep vein thrombosis, 6 weeks of treatment is typically sufficient. VTE triggered by factors such as surgery, oral contraceptives, pregnancy, or leg plaster requires 3 months of treatment. Unprovoked VTE, often associated with atrial fibrillation, may require longer duration of treatment.

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    Dabigatran

    A direct thrombin inhibitor used for prophylaxis in elective knee and hip surgeries.

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    Rivaroxaban

    A direct factor Xa inhibitor used for prevention of VTE (blood clots) in patients undergoing hip or knee replacement, and for treatment of DVT/PE (deep vein thrombosis and pulmonary embolism).

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    Apixaban

    A direct factor Xa inhibitor used for various indications, including prophylaxis in hip and knee surgeries, treatment of DVT/PE, and for prevention of recurrent DVT/PE.

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    What is Dabigatran?

    A direct thrombin inhibitor.

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    What is Rivaroxaban?

    A direct factor Xa inhibitor.

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    What is Apixaban?

    A direct factor Xa inhibitor.

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    What are NOACs?

    NOACs are medications that work by inhibiting specific clotting factors in the body. They're becoming increasingly popular for managing blood clots due to their ease of use and lower bleeding risks compared to traditional warfarin.

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    How does renal function affect NOACs?

    Patients with impaired kidney function might need adjustments in NOAC dosage, as these medications are primarily excreted by the kidneys. In severe cases, NOACs might be avoided altogether.

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    Ischaemic Stroke

    A blood clot blocks blood flow to the brain, causing sudden onset of symptoms lasting longer than 24 hours.

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    Antiplatelet Medication

    Antiplatelets prevent blood clots from forming, useful after an ischaemic stroke.

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    Transient Ischemic Attack (TIA)

    A temporary disruption of blood flow to the brain, causing sudden neurological symptoms lasting less than 24 hours.

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    Drug Precautions for Intracerebral Haemorrhagic Stroke

    Avoid aspirin, statins, and anticoagulants as they increase the risk of bleeding in patients with Intracerebral Haemorrhagic Stroke.

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    Intracerebral Haemorrhagic Stroke

    A weakened blood vessel in the brain bursts, causing a rush of blood out of the brain.

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    Warfarin in pregnancy

    Warfarin is a medication that prevents blood clots. It is not safe for pregnant women, especially during the 1st and 3rd trimesters, due to the risk of birth defects and bleeding.

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    Yellow treatment book

    A yellow treatment book is used to record a patient's international normalized ratio (INR) levels and current warfarin dose. It informs healthcare professionals about the patient's medication regimen.

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    Calciphylaxis

    Calciphylaxis is a condition where calcium builds up in the small blood vessels of the skin and fat tissues, leading to blood clots. This can cause skin cell death due to insufficient blood flow.

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    Stopping Warfarin for Calciphylaxis

    Warfarin should be stopped if calciphylaxis is diagnosed. This is a serious condition that requires immediate medical attention.

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    Warfarin as Vitamin K antagonist

    Warfarin is a vitamin K antagonist, meaning it blocks the absorption of vitamin K, which is essential for blood clotting.

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    Warfarin dosing for rapid anticoagulation

    When rapid anticoagulation is needed, higher doses of warfarin are given initially, followed by adjustments to achieve the desired INR levels.

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    Target INR for Warfarin

    The target INR range for warfarin therapy depends on the patient's medical condition, aiming to keep the range within a narrow window.

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    Monitoring Warfarin therapy

    Monitoring INR, liver function, renal function, and thyroid function is crucial for patients on warfarin therapy to ensure safe and effective treatment.

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    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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    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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