Cancer · UKMLA & AKT
Peri-operative management of anticoagulation
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise peri-operative management of anticoagulation — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- First-line: apixaban (DOAC) - preferred over LMWH; oral, fewer bleeds, no frequent monitoring
- Duration: minimum 6 months for cancer-associated VTE; review ongoing need at 6 months based on cancer status
- DOACs in renal impairment: can be used if eGFR >30 (dose may need adjustment); CKD stage 3a (eGFR 45-59) - DOACs still appropriate
- LMWH - historically first-line for cancer VTE but now superseded by DOACs; renally cleared, given subcutaneously; use heparin (UFH) if significantly reduced renal function
- Warfarin - requires INR monitoring, unpredictable due to drug/diet interactions; not preferred in cancer-associated VTE
- Aspirin - antiplatelet only; no role in treating VTE
Thrombophilia screen is NOT indicated in cancer-associated VTE - the malignancy is the clear trigger. Do not delay treatment to screen.
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