Anti/Pro Coagulation + Plt Drugs

Question 1

What lab test is used to evaluate the extrinsic coagulation pathway

Answer 1

PT
Prothrombin Time

Question 2

what lab test is used to evaluate the intrinsic coagulation pathway

Answer 2

aPTT
Activated partial thromboplastin time

PTT

Question 3

What lab value is used to monitor lower doses of unfractionated heparin, up to ~1.0units/mL

Answer 3

PTT

Question 4

What lab value is used to monitor higher heparin concentrations used during cardiac surgery?

Answer 4

ACT
Activated clotting time

Question 5

PTT, ACT, PT evaluate bleeding. They only examine specific components of the overall coagulation cascade what tests provide multiple insights to the coagulation factor interactions?

Answer 5

TEG
Thromboelastography

Question 6

what are the commonly used TEG variables?

Answer 6

-coagulation time (onset in seconds)
-clot formation time(initial rate of fibrin creation in secs)
-angle (a; in degrees)
-maximum clot firmness(in mm)
-lysis time(in sec, used for diagnosis of premature lysis or hyperfibrinolysis)

Question 7

Antifibrinolytic agents are also known as ______ analogs

Answer 7

Lysine analogs

Question 8

What is the function of Plasmin?

Answer 8

Degrades fibrin clots, fibrinogen, and other plasma proteins

Question 9

MOA of Anti-Fibrinolytics

Answer 9

Competitively inhibit activation of Plasminogen to Plasmin.

Not a prothrombotic but rather a clot stabilizer

Question 10

What are some AntiFibrinolytic Agents

Answer 10

TXA - Tranexamic Acid
Aminocaproic Acid

Question 11

Off label use of TXA common in anesthesia

Answer 11

Trauma 1g IV
Total Joints 1g IV

Cardiac Surg 50mg/kg/dose IV

Question 12

What medication is a V2 analog of Arginine vasopressin that stimulates the release of Vaughan Willebrand factor from endothelial cells?

Answer 12

Desmopressin DDAVP

Question 13

DDAVP shortens the bleeding time of what kinds of patients?

Answer 13

Pts wild mild forms of Hemophilia A or von Willebrand Disease

Question 14

Dosing of DDAVP

Answer 14

DDAVP is administered intravenously at a dose
of 0.3 mcg/kg and should be given over 15 to 30 ­ minutes
to avoid hypotension.

Question 15

What is the only available agent to reverse unfractionated heparin? How does it work?

Answer 15

Protamine
Inactivates acidic heparin via a simple acid base interaction

Question 16

adverse reactions of protamine administration

Answer 16

Anaphylaxis
Acute pulmonary vasoconstriction
Right heart failure
Hypotension

Question 17

What patients are at an increased risk risk for protamine adverse reactions

Answer 17

NPH insulin users
Vasectomy
Multiple drug allergies
Prior protamine exposure

Question 18

dosing of protamine and max dose

Answer 18

1-1.5mg IV per 100 units of Heparin

Max Dose: 50mg/dose

Question 19

What is Idarucizumab and what is it used for?

Answer 19

Reversal of Dabigatran - Pradaxa

Binds to dabigatran and its metabolites, neutralizing its anticoag effects

Question 20

Dose of Idarucizumab

Answer 20

5mg IV, may consider 1x repeat dose

Question 21

What is Andexanet Alfa and how does it work

Answer 21

Reversal for Apixaban and Rivoroxaban

binds and sequesters factor X1 inhibitor and inhibits tissue factor pathway inhibitors. This reverses anti-factor Xa activity and restores thrombin generation.

Question 22

What plasma glycoprotein is synthesized in the liver and a critical component of effective clot formation?

Answer 22

Fibrinogen

Question 22

Fibrinogen is a substrate for what three important enzymes involved in clot formation:

Answer 22

Thrombin
Factor 13a
Plasmin

Question 23

Low fibrinogen levels (<100mg/dL) can increase lab measures including:

Answer 23

PT and PTT
may bot be corrected with FFP

Question 24

Fibrinogen can be repleted with? Dose?

Answer 24

Cryoprecipitate 1 unit per 10kg increase fibrinogen by 50-70mg/dL

Question 25

Transfusion guideline recommend increasing fibrinogen levels to?

Answer 25

150-200mg/dL

Question 26

What are Prothrombin Complex Concentrates (PCCs)?

Answer 26

Concentrates of coag factors the include Factors 2, 7, 9!, and 10 in variable concentrations

Question 27

PCC is approved for use in _______ and main contains Factor __

Answer 27

Hemophilia and Factor 9

Question 28

Name some PCCs used for Vitamin K reversal

Answer 28

Kcentra Octaplex FEIBA - contains activated Factor 7 Profilnine - low levels factor 7 Bebulin - low levels factor 7

Question 29

What is the preferred reversal for Warfin?

Answer 29

It is preferable to give PC’s which contain all four vitamin K- dependent coagulation factors and the natural anticoagulants antithrombin and activated protein C

Question 30

A unit of Heparin is defined as:

Answer 30

the volume of heparin-containing solution that will prevent 1 mL of citrated sheep blood from clotting for 1 hour after the addition of 0.2 mL of 1:100 calcium chloride

Question 31

MOA of Unfractionated Heparin

Answer 31

Binds and enhances AntiThrombin III - an anticoagulant

Question 32

Common starting dose of IV Unfractionated Heparin

Answer 32

2000-5000 units IV then titrated to ACT

Question 33

How long should you delay surgery for a patient with normal and abnormal renal function who is received LMWH?

Answer 33

Normal Renal: 12 hours Renal Dysfxn: Longer lol

Question 34

Does protamine neutralize LMWH?

Answer 34

No, not to the extent it does unfractionated

Question 35

Name some Direct Thrombin Inhibitors

Answer 35

IV: Bivalrudin (Angiomax) IV: Argatroban PO: Dabigatran

Question 36

How long before surgery should you stop the IV or PO Direct Thrombin Inhibitors

Answer 36

Bival: 4-6hrs Agratro: 4-6hrs Dabigatran: 48hrs with normal renal fxn.

Question 37

Tissue plasminogen activator (tPA) is indicated for

Answer 37

– Acute ischemic stroke – Acute myocardial infarction – Acute massive PE for lysis