ANTICOAGULATION MANAGEMENT COMPLETE SET OF CURRENT
EXAM QUESTIONS AND CORRECT ANSWERS
Outline of Deck:
1) Describe the process of hemostasis and thrombosis
2) Define dosing requirements of anticoagulant agents
3) Define monitoring parameters of anticoagulation agents
4) Identify common AEs, contraindications, and DDIs of anticoags
5) Understand key points in management of anticoagulation
Define hemostasis
The process by which bleeding stops and is balanced by
procoagulant/regulatory system
Define thrombosis
The formation of a blood clot (thrombus) inside of a blood vessel by the
procoagulant system
Image that shows the balance of clotting
Thrombus Formation Process
Targets for Anticoagulation
Table of Anticlotting Agents
Describe the Clotting Cascade
What are contraindications to anticoagulation therapy?
What is MOA of unfractionated heparin (UFH)?
Acts first by binding to and forming a complex with antithrombin (AT) -->
Causes a conformational change in AT --> accelerates action of AT by 1,000
fold or more --> The AT/Heparin complex then irreversibly inhibits the
activated coagulation factors: IIa, IXa, Xa, XIa, and XIIa
What is the route of administration of heparin?
, IV only
Heparin targets on clotting cascade
What is heparin dosing for VTE prophylaxis?
5,000 units q8h (7,500 units if > 100 kg)
No monitoring required
What is heparin dosing for VTE treatment
What is heparin dosing for Valve and Arrythmias?
70 units/kg IV loading dose
13 units/kg/hr continuous IV infusion
Adjust infusion for target 0.3-0.7 units/mL of heparin correlation
What is heparin dosing in ACS (Low Intensity)?
60 units/kg IV loading dose
12 units/kg/hour continuous IV infusion
Adjust infusion for target 0.3-0.5 units/mL of heparin correlation
UFH aPTT
Heparin Correlation Measurements
What is heparin resistance?
When unusually high doses of heparin are required to achieve therapeutic aPTT
The inability to achieve ACT >400sec despite heparin doses >600 U/kg
What are possible causes of heparin resistance?
1) Antithrombin deficiency
2) Increased heparin clearance (renal)
3) Elevations in binding proteins, FVIII, fibrinogen, or PF4
How should heparin dose be adjusted in instances of heparin resistance?
Dose adjustments should be based on anti-Xa levels
aPTT may not be reflective of anti-thrombotic effect (a pt may require less UFH
via anti-Xa assay)
EXAM QUESTIONS AND CORRECT ANSWERS
Outline of Deck:
1) Describe the process of hemostasis and thrombosis
2) Define dosing requirements of anticoagulant agents
3) Define monitoring parameters of anticoagulation agents
4) Identify common AEs, contraindications, and DDIs of anticoags
5) Understand key points in management of anticoagulation
Define hemostasis
The process by which bleeding stops and is balanced by
procoagulant/regulatory system
Define thrombosis
The formation of a blood clot (thrombus) inside of a blood vessel by the
procoagulant system
Image that shows the balance of clotting
Thrombus Formation Process
Targets for Anticoagulation
Table of Anticlotting Agents
Describe the Clotting Cascade
What are contraindications to anticoagulation therapy?
What is MOA of unfractionated heparin (UFH)?
Acts first by binding to and forming a complex with antithrombin (AT) -->
Causes a conformational change in AT --> accelerates action of AT by 1,000
fold or more --> The AT/Heparin complex then irreversibly inhibits the
activated coagulation factors: IIa, IXa, Xa, XIa, and XIIa
What is the route of administration of heparin?
, IV only
Heparin targets on clotting cascade
What is heparin dosing for VTE prophylaxis?
5,000 units q8h (7,500 units if > 100 kg)
No monitoring required
What is heparin dosing for VTE treatment
What is heparin dosing for Valve and Arrythmias?
70 units/kg IV loading dose
13 units/kg/hr continuous IV infusion
Adjust infusion for target 0.3-0.7 units/mL of heparin correlation
What is heparin dosing in ACS (Low Intensity)?
60 units/kg IV loading dose
12 units/kg/hour continuous IV infusion
Adjust infusion for target 0.3-0.5 units/mL of heparin correlation
UFH aPTT
Heparin Correlation Measurements
What is heparin resistance?
When unusually high doses of heparin are required to achieve therapeutic aPTT
The inability to achieve ACT >400sec despite heparin doses >600 U/kg
What are possible causes of heparin resistance?
1) Antithrombin deficiency
2) Increased heparin clearance (renal)
3) Elevations in binding proteins, FVIII, fibrinogen, or PF4
How should heparin dose be adjusted in instances of heparin resistance?
Dose adjustments should be based on anti-Xa levels
aPTT may not be reflective of anti-thrombotic effect (a pt may require less UFH
via anti-Xa assay)
