Anticoagulation Management Flashcards

A patient on warfarin for atrial fibrillation has an INR of 5.8 with no active bleeding. Which is the most appropriate management?

Answer: Hold 1-2 doses of warfarin and recheck INR in 1-2 days

For supratherapeutic INR without bleeding, holding doses and rechecking is appropriate; large IV vitamin K doses are reserved for serious bleeding.

Which direct oral anticoagulant (DOAC) requires dose adjustment based on a combination of age, weight, AND serum creatinine?

Answer: Apixaban

Apixaban dose reduction requires meeting at least 2 of 3 criteria: age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

A patient with heparin-induced thrombocytopenia (HIT) requires anticoagulation. Which agent is most appropriate?

Answer: Argatroban

Argatroban, a direct thrombin inhibitor, is a first-line option for HIT as it does not cross-react with heparin antibodies.

A patient taking rivaroxaban 20 mg daily needs an elective colonoscopy with polyp removal. When should rivaroxaban be held?

Answer: 48 hours before the procedure

For high bleeding-risk procedures, rivaroxaban should be held for at least 48 hours prior due to its half-life and bleeding risk.

Which monitoring parameter is most important to assess regularly in a patient receiving long-term enoxaparin therapy?

Answer: Platelet count

Platelet counts should be monitored to detect heparin-induced thrombocytopenia (HIT), which can occur with LMWH use.

A pregnant patient in her second trimester requires anticoagulation for a DVT. Which anticoagulant is safest?

Answer: Low molecular weight heparin

LMWH does not cross the placenta and is the recommended anticoagulant throughout pregnancy for VTE treatment.

Which factor most significantly affects dabigatran plasma concentrations and should be assessed before prescribing?

Answer: Renal function (CrCl)

Dabigatran is 80% renally eliminated, making renal function the primary determinant of drug exposure and dosing.