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Reversal agents for oral anticoagulants

doi: 10.1097/01.NPR.0000526791.95979.92
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INSTRUCTIONS Reversal agents for oral anticoagulants


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Lippincott Professional Development will award 1.5 contact hours for this continuing nursing education activity.

Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50–1223.

This activity has been assigned 1.5 pharmacology credits.

Reversal agents for oral anticoagulants

General Purpose: To familiarize nurses with oral anticoagulants and the agents used to reverse them. Learning Objectives/Outcomes: After completing this continuing education activity, you should be able to: 1. Differentiate the purpose, action, and effects of oral anticoagulants. 2. Identify available reversal agents for oral anticoagulants.

  1. DOAC therapy is not indicated for patients with a history of
    1. mechanical heart valve replacement.
    2. Factor V Leiden.
    3. coagulation disorders.
  2. A CHADS2 score is used to determine a patient's stroke risk and need for anticoagulant therapy in patients with a history of
    1. mechanical valve replacement.
    2. venous thrombosis.
    3. AF.
  3. Which of the following statements about vitamin K antagonists is correct?
    1. Vitamin K antagonists have a higher safety and efficacy profile than DOACs.
    2. DOACs have a higher safety and efficacy profile than vitamin K antagonists.
    3. Vitamin K antagonists and DOACs have similar safety and efficacy profiles.
  4. Which anticoagulant works by inhibiting the synthesis of vitamin K–dependent clotting factors?
    1. warfarin
    2. dabigatran
    3. apixaban
  5. Which anticoagulant works by negating the conversion of fibrinogen to fibrin?
    1. warfarin
    2. dabigatran
    3. rivaroxaban
  6. Which anticoagulant works by binding to free and clot-bound factor Xa?
    1. warfarin
    2. dabigatran
    3. rivaroxaban
  7. Renal excretion accounts for 27% of total drug clearance of which anticoagulant?
    1. apixaban
    2. dabigatran
    3. idarucizumab
  8. Which drug is a factor Xa inhibitor?
    1. dabigatran
    2. phytonadione
    3. edoxaban
  9. How quickly does I.V. vitamin K lower the INR compared with oral vitamin K?
    1. I.V. acts almost immediately while oral takes about 12 to 24 hours.
    2. I.V. acts within 6 to 8 hours while oral takes about 24 to 48 hours.
    3. I.V. acts within 12 to 16 hours while oral takes about 48 hours to almost a week.
  10. The ACCP recommends that if there is no bleeding associated with warfarin therapy, vitamin K should not be administered unless the INR is greater than
    1. 5.
    2. 8.
    3. 10.
  11. Which reversal agent contains all of the clotting factors and plasma proteins?
    1. FFP
    2. PCC
    3. idarucizumab
  12. The 3-PCC and 4-PCC reversal agents are effective in reversing
    1. Xa inhibitors.
    2. thrombin inhibitors.
    3. vitamin K antagonists.
  13. Which reversal agent is currently “off label” if used for DOAC reversal?
    1. PCC
    2. idarucizumab
    3. andexanet alfa
  14. Idarucizumab is approved by the FDA as a reversal agent for
    1. edoxaban.
    2. dabigatran.
    3. rivaroxaban.
  15. Once idarucizumab has been drawn up in a syringe, it must be administered within
    1. 1 hour.
    2. 2 hours.
    3. 4 hours.
  16. Which statement is accurate regarding restarting anticoagulants after administration of idarucizumab?
    1. Waiting at least 24 hours to assess the PTT or ECT is required.
    2. Restarting dabigatran is contraindicated.
    3. Anticoagulation should be considered as soon as medically appropriate.
  17. Which ingredient of idarucizumab could cause an adverse reaction in patients with fructose intolerance?
    1. sorbitol
    2. aspartame powder
    3. modified corn starch
  18. Andexanet alfa is in clinical trials for reversal of which group of anticoagulants?
    1. direct thrombin inhibitors
    2. Xa inhibitors
    3. vitamin K antagonists


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