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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?

24
Q

Heparin reversal

A

Stop heparin

Antidote - protamine sulphate

25
What is the antidote for heparin
Protamine sulphate
26
Protamine sulphate completely/partially reverses unfractionated heparin
Completely
27
Protamine sulphate completely/partially reverses LMWH
Partially
28
What is used more commonly? - LMWH - unfractionated heparin
LMWH
29
When would unfractionated heparin be used?
Patient presents with acute thrombosis and you need to anticoagulant IMMEDIATELY - pregnant lady about to give birth - pre surgery
30
What is warfarin metabolised by
Cytochrome P450
31
Warfarin - mechanism
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
Warfarin - monitoring
PT | INR
33
Warfarin - aim for INR range of
2-3
34
What are the 4 vitamin K dependent clotting factors
II, VII, IX, X
35
Warfarin - complications
Bleeding
36
Warfarin - reversal - if mild (bruising, epistaxis)
No action required
37
Warfarin - reversal - high INR
Vitamin K
38
How long does vitamin K take to bring the INR back down to normal range?
6 hours
39
Warfarin - reversal - if life threatening haemorrhage
Administer clotting factors
40
How long does administering clotting factors take to bring the INR back down to normal range?
Does it immediately
41
Why is administering clotting factors for warfarin reversal not done routinely
You expose the patient to many donor blood pools
42
Name 2 types of new anticoagulants
Direct thrombin inhibitors | Xa inhibitors
43
Warfarin - safe to use in pregnancy. True or false?
False | - teratogenic
44
Warfarin - administration route
Oral
45
New anticoagulants - administration route
Oral
46
New anticoagulants - is there an antidote for reversal?
No
47
When are new anticoagulants used
As prophylaxis in elective hip and knee replacement surgery
48
New anticoagulants - thrombin inhibitors - example
Dabigatran
49
New anticoagulants - Xa inhibitors - examples
RivaroXaban | ApiXaban

Haematology SOH (22 decks)

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