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957 Block 2 > 10. Coagulopathy > Flashcards

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
Q

Enoxaparin and Dalteparin have identical molecular weights and can be used interchangably. (T/F)

A

False: they differ in mean molecular weight and are not created equally

26
Q

What is the MOA of Warfarin?

A

The initial formation and propagation of thrombus is prevented because warfarin suppresses the production of clotting factors.

27
Q

Warfarin has no direct effect on previously circulating clotting factors or previously formed thrombus. (T/F)

A

True

28
Q

The full antithrombic effect of Warfarin may take how long to achieve?

A

1 week +

29
Q

What is suggested for VTE prophylaxis in moderate to severe liver disease

A

usual approaches for hospitalized and post-op patients

30
Q

What is suggested for acute VTE with elevated INR in moderate to severe liver disease

A

consider LMWH monotherapy
possible VKA but INR is difficult to monitor
DOACs should be avoided
if anticoagulation is not an option, IVC filter

31
Q

What is suggested for atrial fibrilation in moderate to severe liver disease

A

baseline INR < 1.5 : oral anticoagulation

elevated baseline INR : may consider single or dual antiplatelet therapy

32
Q

What is suggested for mechanical heart valve in moderate to severe liver disease

A

VKA until risk exceeds benefit

957 Block 2 (14 decks)

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