BCACP Anticoagulation Management 4 — Questions and Answers
Question 1: A patient on warfarin for atrial fibrillation has an INR of 5.8 with no active bleeding. Which is the most appropriate management?
- Hold warfarin and administer vitamin K 10 mg IV
- Hold 1-2 doses of warfarin and recheck INR in 1-2 days (Correct answer)
- Continue warfarin and recheck INR in 1 week
- Administer fresh frozen plasma immediately
Correct 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.
Question 2: Which direct oral anticoagulant (DOAC) requires dose adjustment based on a combination of age, weight, AND serum creatinine?
- Rivaroxaban
- Apixaban (Correct answer)
- Dabigatran
- Edoxaban
Correct 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.
Question 3: A patient with heparin-induced thrombocytopenia (HIT) requires anticoagulation. Which agent is most appropriate?
- Low molecular weight heparin
- Warfarin alone
- Argatroban (Correct answer)
- Fondaparinux
Correct answer: Argatroban
Argatroban, a direct thrombin inhibitor, is a first-line option for HIT as it does not cross-react with heparin antibodies.
Question 4: A patient taking rivaroxaban 20 mg daily needs an elective colonoscopy with polyp removal. When should rivaroxaban be held?
- 12 hours before the procedure
- 24 hours before the procedure
- 48 hours before the procedure (Correct answer)
- 72 hours before the procedure
Correct 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.
Question 5: Which monitoring parameter is most important to assess regularly in a patient receiving long-term enoxaparin therapy?
- Anti-Xa levels weekly
- Platelet count (Correct answer)
- INR every 2 weeks
- aPTT daily
Correct answer: Platelet count
Platelet counts should be monitored to detect heparin-induced thrombocytopenia (HIT), which can occur with LMWH use.
Question 6: A pregnant patient in her second trimester requires anticoagulation for a DVT. Which anticoagulant is safest?
- Warfarin
- Rivaroxaban
- Low molecular weight heparin (Correct answer)
- Dabigatran
Correct answer: Low molecular weight heparin
LMWH does not cross the placenta and is the recommended anticoagulant throughout pregnancy for VTE treatment.
Question 7: Which factor most significantly affects dabigatran plasma concentrations and should be assessed before prescribing?
- Hepatic function (Child-Pugh score)
- Renal function (CrCl) (Correct answer)
- Body weight
- Age alone
Correct answer: Renal function (CrCl)
Dabigatran is 80% renally eliminated, making renal function the primary determinant of drug exposure and dosing.
BCACP Anticoagulation Management 4
A patient on warfarin for atrial fibrillation has an INR of 5.8 with no active bleeding.
Which is the most appropriate management?