Acquired bleeding disorders

Question 1

warfarin

Answer 1

Warfarin blocks an enzymes that uses vitamin K to produce clotting factors. increased risk of bleeding. need frequent check ups

Question 2

heparin (Unfractionated Heparin)

Answer 2

Heparin works by inactivating thrombin in the clotting process. This stops the formation of fibrin and so stops blood clots forming. Can be monitored by tests sensitive to anti-thrombin.
increased risk of haemorrhagic stroke

Question 3

fondaparinux

Answer 3

similar to low molecular weight heparin

Question 4

aspirin

Answer 4

Aspirin irreversibly inhibits COX-1 and modifies the enzymatic activity of COX-2. COX-2 and activates plasminogen = breaks down fibrin clots
increased risk of GI bleeds and haemorrhagic stroke.

Question 5

fibrinolytic agents

Answer 5

Activate plasminogen to form plasmin –> degrades fibrin and breaks up thrombi
Bleeding complications related to systemic fibrinogenolysis and lysis of normal hemostatic plugs..

Question 6

how to manage patients with overdoses of anticoagulants

• when bleeding
• when not bleeding

Answer 6

Both: Stop drug! vitamin k injection

• when bleeding: infuse crystalloid solution .
• not bleeding: investigate urine

Question 7

coagulopathy associated with liver disease & management

Answer 7

thrombocytopenia platelet dysfunction, reduced plasma concentration of all coagulation factors as they are manufactured in liver.
delayed fibrin polymerisation due to altered fibrin glycosylation.
management: fresh frozen plasma

Question 8

coagulopathy renal disease & management

Answer 8

haematuria
anaemia due to reduced erythropoietin production.
abnormal platelet function –> bleeding
more BLEEDING
management: careful with anticoagulants and blood pressure meds

Question 9

massive blood loss & management

Answer 9

management: Red cell transfusion
- crystalloids
- clotting factors
- pressure to bleed