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Haematology SOH > Anti-Coagulants > Flashcards

Anti-Coagulants Flashcards

1
Q

Function

A

Stop further blood clots from developing on top of already formed clots

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2
Q

Name 2 conditions where anti-coagulants are indicated

A

AF

Venous thrombosis

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3
Q

In AF, thrombus formed in wall of LA can break off to form an embolus and travel through the circulation until it often lodges in which location?

A

Carotid arteries

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4
Q

Patients with AF must take anticoagulants for short term/long term?

A

Long term

- for life

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5
Q

If patient develops their FIRST venous thrombosis, for how long are anti-coagulants required

A

6 months

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6
Q

If patient has a Hx of venous thrombosis and then develops another DVT, how long are anti-coagulants required?

A

For life

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7
Q

What do anti-coagulants target?

A

Formation of the fibrin clot

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8
Q

Name 3 naturally occurring anticoagulants

A

Antithrombin

Protein C+S

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9
Q

Which naturally occurring anticoagulant(s) falls in the first week of warfarin therapy?

A

Protein C+S

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10
Q

Why is warfarin not a good immediate choice for an acute clot?

A

causes a decrease in naturally occurring anticoagulants protein C+S for the first week of therapy

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11
Q

Which anticoagulant is used in the acute setting as it has an immediate effect?

A

Heparin

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12
Q

What medication is used first line for acute thrombosis?

A

Heparin

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13
Q

Heparin - routes of administration

A

IV

SC

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14
Q

Heparin - mechanism of action

A

Potentiates anti-thrombin

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15
Q

Name 2 forms of heparin

A

Unfractionated

LMWH

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16
Q

What is used more often?

  • LMWH
  • unfractionated heparin
A

LMWH

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17
Q

LMWH route of administration

A

SC

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18
Q

LMWH - mechanism of action

A

When antithrombin (natural) binds to factor Xa, LMWH binds to it to ensure that clotting factors remain switched off

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19
Q

How do you monitor unfractionated heparin ?

A

APTT

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20
Q

How do you monitor LMWH ?

A

Factor Xa assay

Bear in mind that usually no monitoring is required for LMWH

21
Q

Complications of heparin (3)

A 
Bleeding 
Autoimmune phenomenon 
- HITT (heparin induced thrombocytopenia with thrombosis) 
Osteoporosis 
- with long term use
22
Q

Patient on heparin gets regular FBC check ups and nurse notices that the platelet count has suddenly dropped. What does this suggest?

A

Autoimmune phenomenon

- platelets have stuck together to form blood clots

23
Q

Heparin half life?

A

30 mins

24
Q

Heparin reversal

A

Stop heparin

Antidote - protamine sulphate

25
Q

What is the antidote for heparin

A

Protamine sulphate

26
Q

Protamine sulphate completely/partially reverses unfractionated heparin

A

Completely

27
Q

Protamine sulphate completely/partially reverses LMWH

A

Partially

28
Q

What is used more commonly?

  • LMWH
  • unfractionated heparin
A

LMWH

29
Q

When would unfractionated heparin be used?

A

Patient presents with acute thrombosis and you need to anticoagulant IMMEDIATELY

  • pregnant lady about to give birth
  • pre surgery
30
Q

What is warfarin metabolised by

A

Cytochrome P450

31
Q

Warfarin - mechanism

A

Vitamin K antagonist (inhibition of vitamin K)
Blocks the ability of it K to carboxylate the bit K dependent clotting factors (II, VII, IX, X) thereby reducing their coagulant activity

32
Q

Warfarin - monitoring

A

PT

INR

33
Q

Warfarin - aim for INR range of

A

2-3

34
Q

What are the 4 vitamin K dependent clotting factors

A

II, VII, IX, X

35
Q

Warfarin - complications

A

Bleeding

36
Q

Warfarin - reversal - if mild (bruising, epistaxis)

A

No action required

37
Q

Warfarin - reversal - high INR

A

Vitamin K

38
Q

How long does vitamin K take to bring the INR back down to normal range?

A

6 hours

39
Q

Warfarin - reversal - if life threatening haemorrhage

A

Administer clotting factors

40
Q

How long does administering clotting factors take to bring the INR back down to normal range?

A

Does it immediately

41
Q

Why is administering clotting factors for warfarin reversal not done routinely

A

You expose the patient to many donor blood pools

42
Q

Name 2 types of new anticoagulants

A

Direct thrombin inhibitors

Xa inhibitors

43
Q

Warfarin - safe to use in pregnancy. True or false?

A

False

- teratogenic

44
Q

Warfarin - administration route

A

Oral

45
Q

New anticoagulants - administration route

A

Oral

46
Q

New anticoagulants - is there an antidote for reversal?

A

No

47
Q

When are new anticoagulants used

A

As prophylaxis in elective hip and knee replacement surgery

48
Q

New anticoagulants - thrombin inhibitors - example

A

Dabigatran

49
Q

New anticoagulants - Xa inhibitors - examples

A

RivaroXaban

ApiXaban

Haematology SOH (22 decks)

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