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Anticoagulation Management Flashcards

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  1. Which DOAC has the lowest proportion of renal elimination (~27%), making it most suitable in patients with chronic kidney disease?

    Answer: Apixaban

    Apixaban has approximately 27% renal elimination, the lowest among the four approved DOACs, compared to dabigatran (~80%), making it most favorable in CKD patients.

  2. Idarucizumab (Praxbind) is the FDA-approved specific reversal agent for which anticoagulant?

    Answer: Dabigatran

    Idarucizumab is a humanized monoclonal antibody fragment that specifically binds and neutralizes dabigatran's anticoagulant effect.

  3. Andexanet alfa (Andexxa) is FDA-approved for reversal of which anticoagulants in life-threatening bleeding?

    Answer: Rivaroxaban and apixaban

    Andexanet alfa is a modified recombinant Factor Xa decoy protein approved for reversing rivaroxaban and apixaban (both Factor Xa inhibitors) in life-threatening bleeding.

  4. According to AHA/ACC guidelines, oral anticoagulation is RECOMMENDED (not merely considered) for males with nonvalvular atrial fibrillation when their CHA2DS2-VASc score reaches:

    Answer: 2 or greater

    AHA/ACC guidelines recommend oral anticoagulation for males with nonvalvular AF and CHA2DS2-VASc score of 2 or greater; a score of 1 makes anticoagulation reasonable but not definitively recommended.

  5. Which anticoagulant regimen is now preferred over LMWH for cancer-associated thrombosis in patients without high gastrointestinal or genitourinary bleeding risk?

    Answer: Apixaban or rivaroxaban (direct oral anticoagulants)

    Updated ISTH and ASCO guidelines recommend DOACs (apixaban or rivaroxaban) over LMWH as preferred therapy for cancer-associated thrombosis in appropriate patients.

  6. A patient taking apixaban requires emergent surgery within 8 hours after a serious fall. Which is the most appropriate reversal strategy?

    Answer: Andexanet alfa per weight-based dosing protocol

    Andexanet alfa is the FDA-approved specific reversal agent for apixaban and rivaroxaban, indicated for life-threatening or urgent surgical bleeding situations.

  7. All DOACs are contraindicated for stroke prevention in atrial fibrillation in patients with which of the following conditions?

    Answer: Mechanical prosthetic heart valve

    All DOACs are contraindicated in patients with mechanical prosthetic heart valves, as clinical trials demonstrated significantly higher rates of stroke and bleeding compared to warfarin.