ANTICOAGULATION CORRECT ANSWERS TO NEW EXAM
QUESTIONS FOR SURE SUCCESS
What is the final enzyme in the clotting cascade? - ANSWER Thrombin
What enzyme produces fibrin? - ANSWER thrombin
What is thrombin's action on fibrinogen? - ANSWER splits fibrinogen to fibrin
what 5 things does thrombin activate? - ANSWER Activates procoagulant
factors: V, VIII,XI, XIII
activates platelets
how do direct thrombin inhibitors work on thrombin? - ANSWER Direct
thrombin inhibitors are able to block the action of both forms of Thrombin:
circulating and clot-bound
how does heparin work on thrombin? - ANSWER Heparin only inhibits the
circulating thrombin via antithrombin
where is Factor Xa in the clotting cascade? - ANSWER upstream of thrombin in
the clotting cascade
What happens to thrombin when Factor Xa is inhibited? - ANSWER inhibition
of Factor Xa can PRVENT increased thrombin
How does Factor Xa create thrombin? - ANSWER one molecule of factor Xa
can split over 1000 prothrombin molecules into thrombin
How do Direct Xa inhibitors work on Factor Xa? - ANSWER is able to block
factor Xa found in the circulating and clot-bound forms
,How does heparin work on factor Xa? - ANSWER heparin is only able to
inactivate factor Xa in the fluid phase via antithrombin
2 examples of antiplatelet meds - ANSWER asa
plavix
What 2 types of agents do antithrombotic include? - ANSWER antiplatelet
anticoagulant
What type of agents inhibits one or more steps in the clotting cascade? -
ANSWER anticoagulants
4 medication examples for anticoagulants - ANSWER Unfractionated heparin
low molecular weight heparin (lovenox)
Fondaparinux
vitamin K antagonists (warfarin)
What medication is the only direct thrombin inhibitor? - ANSWER pradaxa
2 medications that are direct factor Xa inhibitors - ANSWER rivaroxaban
(xarelto)
apixaban (eliquis)
end in -xaban
"BANS the Xa is a good way to remember"
3 things to keep in mind when considering warfarin for a patient? - ANSWER
consider if patient is going to be non-adherent to meds
will they follow a vit. K restricted diet?
Will they come in for INR checks?
4 variables that can affect how warfarin works - ANSWER GI disorders
Vitamin K intake
med interactions
poor oral intake
6 cases where you would NOT use direct thrombin and Xa inhibitors -
ANSWER 1. prosthetic heart valves
2.pregnancy
3.renal impairment
4.severe liver disease
, 5.antiphospholipid syndrome
6. GI disease: hx of bleeding or dyspepsi
reversal agent for heparin - ANSWER protamine sulfate
reversal agent for warfarin - ANSWER Vitamin K
Reversal agent for direct oral anticoagulants - ANSWER prothrombin complex
concentrate
reversal agent for dabigatran - ANSWER praxbind
2 reversal agents for Xa inhibitors - ANSWER AndexXa
prothrombin complex concentrate
Warfarin Absolute Contraindications - ANSWER -The presence of a severe or
active bleeding diathesis
-Non-adherence to medication and international normalized ratio (INR)
monitoring
-Pregnancy (avoided at least during the first trimester and from about 2 to 4
weeks before delivery)
-Allergy or intolerance to warfarin (consider warfarin alternative -
Nicoumalone)
Warfarin Relative Contraindications - ANSWER -Uncontrolled hypertension
(greater than 180/100 mm Hg)
-Severe liver disease
-Recent surgery and procedures involving the nervous system, spine, or eye
Warfarin Recommendations - ANSWER 1. Obtain baseline INR
Warfarin INR Target - ANSWER Range of 2.0-3.0 for most indications
Range of 2.5-3.5 for mechanical heart valves in mitral position and non-bileaflet
valve in aortic position
QUESTIONS FOR SURE SUCCESS
What is the final enzyme in the clotting cascade? - ANSWER Thrombin
What enzyme produces fibrin? - ANSWER thrombin
What is thrombin's action on fibrinogen? - ANSWER splits fibrinogen to fibrin
what 5 things does thrombin activate? - ANSWER Activates procoagulant
factors: V, VIII,XI, XIII
activates platelets
how do direct thrombin inhibitors work on thrombin? - ANSWER Direct
thrombin inhibitors are able to block the action of both forms of Thrombin:
circulating and clot-bound
how does heparin work on thrombin? - ANSWER Heparin only inhibits the
circulating thrombin via antithrombin
where is Factor Xa in the clotting cascade? - ANSWER upstream of thrombin in
the clotting cascade
What happens to thrombin when Factor Xa is inhibited? - ANSWER inhibition
of Factor Xa can PRVENT increased thrombin
How does Factor Xa create thrombin? - ANSWER one molecule of factor Xa
can split over 1000 prothrombin molecules into thrombin
How do Direct Xa inhibitors work on Factor Xa? - ANSWER is able to block
factor Xa found in the circulating and clot-bound forms
,How does heparin work on factor Xa? - ANSWER heparin is only able to
inactivate factor Xa in the fluid phase via antithrombin
2 examples of antiplatelet meds - ANSWER asa
plavix
What 2 types of agents do antithrombotic include? - ANSWER antiplatelet
anticoagulant
What type of agents inhibits one or more steps in the clotting cascade? -
ANSWER anticoagulants
4 medication examples for anticoagulants - ANSWER Unfractionated heparin
low molecular weight heparin (lovenox)
Fondaparinux
vitamin K antagonists (warfarin)
What medication is the only direct thrombin inhibitor? - ANSWER pradaxa
2 medications that are direct factor Xa inhibitors - ANSWER rivaroxaban
(xarelto)
apixaban (eliquis)
end in -xaban
"BANS the Xa is a good way to remember"
3 things to keep in mind when considering warfarin for a patient? - ANSWER
consider if patient is going to be non-adherent to meds
will they follow a vit. K restricted diet?
Will they come in for INR checks?
4 variables that can affect how warfarin works - ANSWER GI disorders
Vitamin K intake
med interactions
poor oral intake
6 cases where you would NOT use direct thrombin and Xa inhibitors -
ANSWER 1. prosthetic heart valves
2.pregnancy
3.renal impairment
4.severe liver disease
, 5.antiphospholipid syndrome
6. GI disease: hx of bleeding or dyspepsi
reversal agent for heparin - ANSWER protamine sulfate
reversal agent for warfarin - ANSWER Vitamin K
Reversal agent for direct oral anticoagulants - ANSWER prothrombin complex
concentrate
reversal agent for dabigatran - ANSWER praxbind
2 reversal agents for Xa inhibitors - ANSWER AndexXa
prothrombin complex concentrate
Warfarin Absolute Contraindications - ANSWER -The presence of a severe or
active bleeding diathesis
-Non-adherence to medication and international normalized ratio (INR)
monitoring
-Pregnancy (avoided at least during the first trimester and from about 2 to 4
weeks before delivery)
-Allergy or intolerance to warfarin (consider warfarin alternative -
Nicoumalone)
Warfarin Relative Contraindications - ANSWER -Uncontrolled hypertension
(greater than 180/100 mm Hg)
-Severe liver disease
-Recent surgery and procedures involving the nervous system, spine, or eye
Warfarin Recommendations - ANSWER 1. Obtain baseline INR
Warfarin INR Target - ANSWER Range of 2.0-3.0 for most indications
Range of 2.5-3.5 for mechanical heart valves in mitral position and non-bileaflet
valve in aortic position
