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Chapter 7. Anticoagulation/Venous Thromboembolism

Which are FDA-approved indications for the oral factor Xa inhibitors? Select all that apply.

a. Treatment of deep vein thrombosis (DVT)

b. Postoperative DVT prophylaxis

c. Prevention of stroke in atrial fibrillation

d. Treatment of pulmonary embolism (PE)

e. Treatment of acute stroke

Answers a, b, c, and d are correct. All oral factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban) are approved for treatment of DVT or PE. Although edoxaban is not approved for initial treatment of DVT or PE, it can be initiated for treatment after 5 days of parenteral anticoagulation.

Answer e is incorrect. Oral factor Xa inhibitors are not indicated to treat acute stroke.

A 55-year-old woman was just admitted to the internal medicine floor for treatment of pulmonary embolism (PE). Which of the following agents can be used for initial treatment of her PE? Select all that apply.

a. Pradaxa®

b. Xarelto®

c. Savaysa®

d. Lovenox®

Answers b and d are correct. Both rivaroxaban and enoxaparin are indicated for initial treatment of PE. Apixaban while not listed may be used as well for initial treatment.

Answers a and c are incorrect. Dabigatran and edoxaban may be used for treatment of PE only after a minimum of 5 days of treatment with a parenteral anticoagulant such as enoxaparin.

An 83-year-old man is diagnosed with a new deep vein thrombosis (DVT). He weighs 80 kg (height = 70”) and his serum creatinine (SCr) is 1.6 mg/dL. His past medical history includes type 2 diabetes and gastroesophageal reflux disease (GERD). Which is an appropriate initial treatment recommendation?

a. Xarelto® 15 mg BID for 21 days then 20 mg once daily

b. Eliquis® 5 mg BID for 7 days then 2.5mg BID

c. Lovenox® 120 mg BID

d. Pradaxa® 150 mg BID

Answer a is correct. For treatment of DVT or PE, rivaroxaban must be dosed at 15 mg BID for 21 days followed by 20 mg once daily with the evening meal.

Answer b is incorrect. The appropriate dose for DVT/PE treatment with apixaban is 10 mg BID for 7 days followed by 5 mg BID. While the patient is ≥80 years old ...

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