Question

A58-year-old woman with chronic hypertension and diabetes mellitus was recently admitted to the hospital for congestive heart failure and new onset atrial fibrillation. She is now seeing you after discharge and, though feeling better, is still in atrial fibrillation. An echocardiogram shows an ejection fraction of 40%; there are no valvular abnormalities. An ECG reveals only atrial fibrillation. You calculate her risk using the CHADS (2) system and the score indicates that she requires anticoagulation rather than antiplatelet therapy. Questions 1–3.
1. You are discussing the risks and benefits of anticoagulation therapy with her, including the option of using direct thrombin inhibitors. Which of the following anticoagulants is a direct inhibitor of thrombin?
(A) Abciximab (B) Dabigatran (C) Rivaroxaban (D) Warfarin

2. She tells you that her main reason for not wanting oral anticoagulation is that she does not want to come to clinic for frequent blood draws. You agree on an oral alternative and start her on apixaban. You counsel her extensively on the importance of taking the medication each day, as suddenly stopping can lead to
(A) Anaphylaxis
(B) Excess bleeding (C) Increase in INR (D) Stroke
(E) Thrombocytopenia

3. She is excited about not having to come in for blood tests but wonders if there is a test, just in case the doctors need to know. Which of the following tests would provide accurate information about the coagulation status of a patient taking apixaban?
(A) aPTT
(B) Factor X test
(C) INR
(D) PT test

Answer 1

ANSWERS :

1)Option B - Dabigatran

Explanation :

• Dabigatran : Direct thrombin inhibitor
• Abciximab : Inhibits platelet aggregation
• Rivaroxaban : Factor Xa inhibitor
• Warfarin : Inhibits vit K dependent cofactors II ,VII,IV,X along with protein C and protein S

2)Option D - Stroke

Reason :

Sudden stoppage of anticogulants ------> formation blood clot --------> blocks the blood flow in blood vessels ------> decreased or stoppage of oxygen to brain ------> stroke