BCACP Anticoagulation Management 4

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?

Accepted Answer

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

Answer

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?

Accepted Answer

Apixaban

Answer

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?

Accepted Answer

Argatroban

Answer

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?

Accepted Answer

48 hours before the procedure

Answer

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?

Accepted Answer

Platelet count

Answer

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

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test