Anticoagulant Workshop 2022

What are the 3 factors in Virchow triad that are responsible for the risk of thrombosis?

• Hypercoagulability

• Stasis

• Thrombophilia

• Endothelial injury

Which category in COVID-19 patient that you should start consider anticoagulant based on our latest Malaysia guideline?

• 1

• 2

• 3

• 4

In older people with Atrial Fibrillation, which of the following is FALSE?

I) Anticoagulant should be avoided in frail older people with HAS-BLED score >5

II) Dabigatran 110mg BD should be used in patients age ≥80, concomitant use of Amlodipine OR increased bleeding risk

III) Apixaban 2.5mg BD should be used for patients age ≥80, ≤60kg OR serum Creatinine ≥133umol/L

IV) Rivaroxaban 15mg OD if CrCl 15-30mL/min

• I, II

• I, II, III

• II, IV

• All of the above

In normal renal function the anticoagulant effects of DOAC usually wear off in ___________

• 24 – 48 hrs

• 12 - 24 hrs

• 6 - 12 hrs

• 3 – 6 hrs

What do our experts recommend as first line reversal agents for Factor Xa inhibitors (Apixaban,Rivaroxaban) and Direct thrombin inhibitor (Dabigatran)?

• Andexanet Alfa and Idarucizumab

• 4-factor PCC at dose of 50IU/kg up to 2,000 units and Idarucizumab

• Activated charcoal

• 4-factor PCC

A 70 year old man with history of atrial fibrillation and diabetes presented with right sided upper and lower limb weakness and dysartria which started an hour ago. His medication history includes Dabigatran 110mg BD and Sitagliptin 100mg BD. On examination, power on the affected side is 4/5. NIHSS score was 1. HAS-BLED score rather low. CT Brain was normal. Diagnosis of left lacunar stroke was made and decided not to thrombolyse. His blood investigation shows LDL of 3.2, Creatinine 98 micromol/L. What would be your next course of action in regards to optimization of his risk factors control?

• Stop Dabigatran and start tablet aspirin 150mg OD

• Add on tablet aspirin 150mg OD

• Add on tablet aspirin 150mg OD and lipid-lowering medication

• Increase Dabigatran to 150mg BD and add on lipid-lowering medication

Conditions that increase the risk of systemic embolisation in patients with LV thrombus are following except

• Severe congestive heart failure

• Diffuse LV dilatation and systolic dysfunction

• Previous embolisation

• Young age

Which trial showed the benefits of double therapy over triple therapy with VKA in

post-PCI AF patients

• ENTRUST-AF-PCI Trial

• WOEST Trial

• AUGUSTUS Trial

• PIONEER AF-PCI Trial

What is the new recommended duration of triple therapy, followed by double

therapy as the default post-PCI treatment strategy for AF patients in the latest 2021 North American consensus statement and 2020 ESC guidelines:

• 1 week

• 4 weeks

• 12 weeks

• 24 weeks

A 30 year old lady with no known illnesses presents with few episodes of seizures preceded by headache for 3 days. On examination, she had a mild right sided weakness and fully conscious. An urgent CT Brain and Contrasted CT Brain showed subcortical Left parietal infarct with no hemorrhagic transformation and left transverse and sigmoid sinus thrombosis. A diagnosis of unprovoked cerebral venous thrombosis was made. What will be your long-term anticoagulation strategy?

• Sub-Cutaneous enoxaparin 1mg/kg twice a day throughout duration of treatment

• Start warfarin with bridging therapy using sub-cutaneous enoxaparin

• Counsel patient in regards to advantages and disadvantages, as well as indications of warfarin and dabigatran. Thereafter allow patient to decide on therapy she prefers.

• Start dabigatran 150mg BD without bridging therapy