MTM Anticoagulation Management 2

Question 1

A patient on warfarin presents with an INR of 8.2 and no active bleeding. Which management approach is most appropriate?

Accepted Answer

Hold warfarin, give oral vitamin K 2.5 mg, and recheck INR in 24 hours

Answer

For supratherapeutic INR >8 without bleeding, holding warfarin and giving low-dose oral vitamin K (2.5–5 mg) with close INR follow-up is standard management.

Question 2

Which direct oral anticoagulant (DOAC) requires dose adjustment based on a triple criterion of age, weight, and serum creatinine?

Accepted Answer

Apixaban

Answer

Apixaban uses a 'two-of-three' dose reduction criterion: age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL to reduce to 2.5 mg twice daily.

Question 3

A patient with mechanical mitral valve replacement asks about switching from warfarin to a DOAC. What is the appropriate recommendation?

Accepted Answer

DOACs are contraindicated in patients with mechanical heart valves

Answer

DOACs are contraindicated in patients with mechanical heart valves due to increased rates of thromboembolic events and bleeding demonstrated in the RE-ALIGN trial.

Question 4

A patient receiving therapeutic enoxaparin for DVT has a creatinine clearance of 18 mL/min. What adjustment is required?

Accepted Answer

Switch to UFH infusion or reduce enoxaparin dose to 1 mg/kg once daily

Answer

Enoxaparin accumulates in severe renal impairment (CrCl <30 mL/min), requiring dose reduction to 1 mg/kg once daily or switching to UFH.

Question 5

Which reversal agent is specifically approved for reversing rivaroxaban and apixaban anticoagulation?

Accepted Answer

Andexanet alfa

Answer

Andexanet alfa is a recombinant factor Xa decoy approved for reversing rivaroxaban and apixaban in life-threatening or uncontrolled bleeding.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Anticoagulation Management 2