10. Coagulopathy Flashcards

1
Q

Coagulopathy is a complication of what underlying disease?

A

Cirrhosis (liver disease)

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2
Q

In cirrhosis, liver cells are replaced by what?

A

fibrosis

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3
Q

High amount of fibrosis results in _______ (↑/↓) blood flow to and through the liver.

A

decrease ↓

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4
Q

What are 4 complications of cirrhosis?

A
  • splenic congestion
  • portal hypertension
  • fluid accumulation
  • increased bilirubin
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5
Q

What is the consequence of splenic congestion?

A

thrombocytopenia

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6
Q

What is thrombocytopenia?

A

deficiency in platelets

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7
Q

What is a consequence of portal HTN?

A

varices

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8
Q

What is a consequence of fluid accumulation?

A

ascites

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9
Q

What are signs of increased bilirubin?

A

jaundice

dark urine

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10
Q

What is the threshold of diagnosing thrombocytopenia?

A

platelets < 150,000

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11
Q

What are the causes of coagulopathy in cirrhosis?

A
hepatocyte loss (diminished synthetic function)
thrombocytopenia
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12
Q

Portal vein thrombosis is a very rare complication of liver cirrhosis. (T/F)

A

False: it is a fairly common complication

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13
Q

A randomized controlled trial has shown that what medication is effective for primary prevention of PVT in liver cirrhosis?

A

anticoagulation therapy

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14
Q

What is unfractionated Heparin?

A

heterogeneous mixture of glycosaminoglycans

MW = 3,000 - 30,000 daltons

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15
Q

What is the MOA of unfractionated Heparin?

A

binds to and catalyzes antithrombin III

inactivates factors IIa, Xa, IXa, XIa, XIIa

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16
Q

What makes unfractionated Heparin have variable pharmacokinetics and anticoagulant response?

A

binds to endothelial cells, macrophages, platelets, and plasma proteins

17
Q

What are 3 contraindications of unfractionated Heparin?

there are 5 total

A
  • active bleeding
  • hemophilia
  • thrombocytopenia
  • intracranial hemorrhage
  • severe hypertension
18
Q

What are 3 ADRs of unfractionated Heparin?

A
  • bleeding
  • osteoporosis
  • heparin induced thrombocytopenia
19
Q

What monitoring is required for Heparin?

A
  • aPTT (1.5 - 2.5 times control value)
  • platelet count
  • hemoglobin and hematocrit
  • bleeding
20
Q

With regards to unfractionated Heparin, what specific factors should be considered with the aPTT?

A

anti-factor Xa level 0.3 - 0.7 IU/mL
check q 6 hrs - adjust dose according to protocol
check q 24 hrs after 2 aPTTs within therapeutic range

21
Q

What is low molecular weight Heparin?

A

polysulfated glycosaminoglycans

MW = 4,000-5,000 daltons

22
Q

What is the MOA of low molecular weight Heparin?

A

binds and catalyzes antithrombin III

23
Q

Why does low molecular weight Heparin have superior pharmacokinetics to unfractionated Heparin?

A

reduced binding to plasma proteins
reduced binding to macrophages and endothelial cells
reduced binding to platelets

24
Q

What are the low molecular weight Heparin agents?

A

enoxaparin (Lovenox)

Dalteparin (Fragmin)

25
Enoxaparin and Dalteparin have identical molecular weights and can be used interchangably. (T/F)
False: they differ in mean molecular weight and are not created equally
26
What is the MOA of Warfarin?
The initial formation and propagation of thrombus is prevented because warfarin suppresses the production of clotting factors.
27
Warfarin has no direct effect on previously circulating clotting factors or previously formed thrombus. (T/F)
True
28
The full antithrombic effect of Warfarin may take how long to achieve?
1 week +
29
What is suggested for VTE prophylaxis in moderate to severe liver disease
usual approaches for hospitalized and post-op patients
30
What is suggested for acute VTE with elevated INR in moderate to severe liver disease
consider LMWH monotherapy possible VKA but INR is difficult to monitor DOACs should be avoided if anticoagulation is not an option, IVC filter
31
What is suggested for atrial fibrilation in moderate to severe liver disease
baseline INR < 1.5 : oral anticoagulation | elevated baseline INR : may consider single or dual antiplatelet therapy
32
What is suggested for mechanical heart valve in moderate to severe liver disease
VKA until risk exceeds benefit