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Year 3 - Haematology > Anti-Coagulant Therapy > Flashcards

Anti-Coagulant Therapy Flashcards

1
Q

Which clotting factors does warfarin therapy affect?

A

II, VII, IX, X

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2
Q

What is the action of anticoagulants?

A

Targets formation of the fibrin clot

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3
Q

Give indications for anticoagulant therapy

A

VT

AF

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4
Q

How soon does heparin show an effect?

A

Immediately

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5
Q

How does unfractionated heparin work?

A

Keeps anti-thrombin and thrombin bound together

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6
Q

How does LMWH heparin work?

A

Binds to thrombin to switch off factor Xa

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7
Q

How long does warfarin take to work?

A

7 days

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8
Q

How is heparin monitored?

A

APPT

Anti-Xa assay

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9
Q

How is LMWH monitored?

A

Not req’d

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10
Q

A prolonged PT in heparin used suggests what?

A

over-coagulation

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11
Q

How is warfarin therapy monitored?

A

INR

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12
Q

Where is heparin made in the body?

A

Mast cells

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13
Q

What does a sharp drop in platelets on heparin therapy indicate?

A

Autoimmune consumptive thrombocytopenia

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14
Q

How long does the effect of LMWH take to wear off?

A

12-24 hours

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15
Q

What can be given in severe bleeding in patients on unfractionated heparin?

A

Protamine sulphate

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16
Q

What does protamine sulphate do?

A

Reverse the antithrombin effect of heparin by “switching off” heparin

17
Q

Give examples of coumarin anticoags?

A

Warfarin

Phenindone

18
Q

What is the action of coumarin anti-coags?

A

Inhibit vitamin K synthesis

19
Q

Where is vitamin K absorbed?

A

Upper intestine

20
Q

Why is carboxylation important in factors II, VII, IX, X synthesis?

A

Adds COOH group which binds to calcium to attract platelets

21
Q

Which enzyme metabolises warfarin?

A

Cytochrome P450

22
Q

Which coag factor has the shortest half life?

A

Factor VII

23
Q

What are the adverse effects of warfarin?

A

Bruising
Epistaxis
Haematuria
GI or cerebral bleeds

24
Q

If there INR is too high on warfarin, but under 6, what action should be taken?

A

Miss a few doses of warfarin

25
Q

If the INR is over 8 on Warfarin therapy what action should be taken?

A

Give vit K

26
Q

How long does vit K take to work in reversal of warfarin therapy?

A

6 hours

27
Q

What can be given in high INR and emergency/severe bleed to reverse warfarin therapy?

A

Factor concentrates

28
Q

How long do factor concentrates take to reverse warfarin therapy?

A

Immediate action

29
Q

Give examples of Xa inhibitors?

A

Rivaroxaban
Edoxaban
Apixaban

30
Q

Give examples of direct thrombin inhibitors?

A

Dabigatran

31
Q

How is dabigatran excreted?

A

Renally

32
Q

What is the downside to new oral anticoags?

A

No reversal

Year 3 - Haematology (17 decks)

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