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Anticoagulation Management Flashcards

7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A patient with acute PE is found to have antiphospholipid syndrome (APS). Which anticoagulant strategy is preferred for long-term management?

    Answer: Warfarin with target INR 2–3

    Warfarin remains the preferred anticoagulant for APS because DOACs have been associated with higher rates of arterial thromboembolism in this population.

  2. When monitoring unfractionated heparin (UFH) therapy using anti-Xa levels, what is the therapeutic target range for treatment of VTE?

    Answer: 0.5–1.0 units/mL

    The therapeutic anti-Xa range for UFH treatment of VTE is 0.3–0.7 units/mL (some guidelines specify 0.3–0.7 or up to 1.0 units/mL depending on the protocol).

  3. A 72-year-old patient with non-valvular atrial fibrillation has a CHA₂DS₂-VASc score of 2. What is the recommended anticoagulation approach?

    Answer: Oral anticoagulation is recommended

    A CHA₂DS₂-VASc score ≥2 in males (or ≥3 in females) indicates high stroke risk and warrants oral anticoagulation therapy.

  4. Which of the following is a contraindication to the use of fondaparinux?

    Answer: Severe renal impairment (CrCl <30 mL/min)

    Fondaparinux is contraindicated in severe renal impairment (CrCl <30 mL/min) due to drug accumulation and excessive bleeding risk.

  5. A pharmacist reviews a patient's medication list and notes they are on warfarin plus amiodarone started 3 months ago. The INR is now 4.8. What best explains this interaction?

    Answer: Amiodarone inhibits CYP2C9 and CYP3A4, reducing warfarin clearance

    Amiodarone inhibits CYP2C9 and CYP3A4, reducing warfarin metabolism; because amiodarone has a very long half-life, this interaction can persist for months after drug initiation.

  6. During an MTM session, a patient on dabigatran reports taking an over-the-counter proton pump inhibitor. What counseling point is most relevant?

    Answer: PPIs reduce dabigatran bioavailability by increasing gastric pH

    Dabigatran is formulated as a prodrug requiring an acidic gastric environment; PPIs raise gastric pH and reduce dabigatran bioavailability by approximately 12–30%.

  7. A patient with provoked DVT (post-surgical) completes 3 months of anticoagulation with no residual risk factors. What is the recommended duration of therapy?

    Answer: 3 months is sufficient; discontinue anticoagulation

    For provoked VTE with a transient reversible risk factor, 3 months of anticoagulation is adequate and indefinite therapy is not recommended.