Bleeding disorders Flashcards
WHat are the uses of tranexamic acid?
An antifibrinolytic that is used to prevent or treat bleeding associarted with excessive fibrinolysis, e.g, surgery, dental extraction, obsteric disorders, menorrhagia, hereidatry angioedema, epistaxis, thrombolytic overdose.
What is desmopressin used for?
Mild-mod haemophilia, von willebrand disease, firbonytic response testing.
What patients are at high risk of a VTE when admitted to hospital?
Anticipated to have a substantial reduction in mobility, obesity, malignant disease, history of VTE, thrombophilli disorder, 60+ years.
What VTE prophylaxis is preferred in renal failure pts?
Heparin (unfractioned)
How long should VTE pharmacological prophylaxis be used for in general surgery and major surgery?
5-7 days until mobility has been re-established for general surgery and 28 days after a major surgery such as cancer, hip or knee surgery.
What is the inital treatment of a VTE
LMWH or unfractioned heparin, as IV loading dose followedby continuous IV infusion or intermittent SC.
When should warfarin be used in VTE?
Immediately with heparin IV doses until INR stabilised to >2 for atleast 24 hours, hpearins should be used for atleast 5 days until maintenance dose of warfarin is achieved.
What VTE should be used in pregnancy?
Heparins, as they do not cross the BBB, LMWH are preferred because they have a lower risk of osteoporosis and induced thrombocytopenia, higher doses are required as they are eliminated more rapidly in pregnancy.
What should you do if a haemorrhage occurs whilst taking heparins?
In most cases withdrawal of heparin is sufficient, if rapid reversal is required protamine sulfate can be used which is a specific antidote.
What is given to a patient suffering from a suspected TIA?
Aspirin or if CI then clopidogrel
What is the maximum time frame for alteplase to be administered following a stroke?
4.5 hours, to be administered by trained medical staff preferably in a specialist stroke centre
When should aspirin be initiated following thrombolysis?
24 hours after thrombolysis or asap (within 48 hours of onset of symptoms) if not receiving thrombolysis
True or false. Anticoagulants can be used as an alternative to antiplatelets in stroke management?
False, not recommended as alternatives
What long term treatment is recommended following a TIA or ischaemic stroke?
Clopidogrel (unlicensed in TIA) long-term, or a combination or monotherapy of dipyridamole or aspirin if either \both CI or intolerable.
Stain initiated 48hrs after symptoms of stroke irrespective of serum cholesterol concentrations.
Hypertensive treatment following the acute phase with a target of <130/80 (b blockers not to be used unless indicated for coexisting condition
Lifestyle changes to diet, exercise, weight, alcohol and smoking.
How does long term management following a stroke differ to a pt with AF?
Anticoagulants for long term prevention
How does long term management differ in intracerebral hemorrhage?
Anticoagulants not recommended even if pt has AF, unless at high risk of an event. Aspirin only given in high risk of cardiac events. BP should be monitored and treated appropriately. Stations to be avoided unless risk of vascular event outweighs risk of further haemorrhage.
What are anticoagulants used for?
Prevent thrombus formation in the venous side of circulation
Why are anticoagulants more effective in veins rather than arteries?
Thrombi in the veins consist of fibrin web enmeshed with platelets and RBC. In the arteries thrombi have little fibrin.
How long does it take for warfarin effects to develop fully?
48-72 hours. Heparins to be used concomitantly for
Target values rather than ranges are now recommended.
INR 2.5 for: tx of DVT or pulmonary embolism, AF, cardioversion, dilated cardiomyopathy, mitral stenosis
INR3 .5 for: recurrent DVT or pulmonary embolism.
An INR of 3 is recommended for pt with prosthetic heart valve?
False. INR differs on type and location of valve.
How long should anticoagulants be used for following a DVT?
6 weeks for isolated calf vein DVT. 3 month for provoked or with transient risk factors (contraceptive, pregnancy, long haul flights), at least 3 months for unpro
In the event of a patient taking warfarin suffering a major bled what is the most appropriate action to take?
Stop warfarin, give vit K by slow IV, give dried prothrombin complex or fresh frozen plasma if unavailable.
Pts on warfarin are advised to stop warfarin 5 days before elective surgery, if a pt is at high risk of thromboembolism what is recommended?
Stop warfarin and use LMWH until 24 hours before surgery. Warfarin can be resumed next day.
What should be given to warfarin pts in an emergency surgery?
If surgery can be delayed for 6-12 hours but I can be given iv but if not dried prothrombin complex and vit k.
Which type of heparin has longer duration of action?
LMWH, used routinely but for pts at high bleeding risk unfractioned can be usedas its effects can be stopped by removing the infusion.
Heparin induced thrombocytopenia (low levels of platelets) is a risk of administering heparin. What type of heparin has a lower risk of HIT?
LMWH, they are the preferred heparin for prevention of VTE as they are as effective and have a lower risk of HIT.
Can you give an antiplatelet and anticoagulant ntogether?
Yes, should be used for minimal amount of time.
What is the MOA of fondiparinux?
Inhibits activated factor x
When can clopidogrel and aspirin be used?
STEMI, NSTEMI, percutaneous coronary intervention, atherothrombotic and thromboembolic events in AF pts
What is the recommended treatment length for aspirin and clopidogrel in a STEMI and a NSTEMI?
STEMI: at least 4 weeks, optimum treatment duration has not been established.
NSTEMI: up to 12 months
What is an alternative to low dose aspirin and why would a switch be considered?
Clopidogrel, if hypersensitive or intolerable even with PPI
What alternatives can be given for clopidogrel in pts undergoing PCI?
Prasugrel or ticagrelor
What effects would you see in an aspirin overdose?
Hyperventilation, tinnitus, deafness, vasodilation, sweating. Coma indicates very severe
You receive a prescription for a 34yr old male for aspirin, no strength has been stated and the directions are ASD. What strength of aspirin do you give?
BP directs that when no strength has been stated, 300mg should be prescribed
What factor does rivaroxoban, apixiban, edoxoban inhibit?
Factor xa
What monitoring should be taken in pts recieving heparin?
Platelet count before treatment and regularly if given long term. Potassium plasma concentrations before and regularly in pts at risk of hyperkalemia (diabetes, renal failure, acidosis, taking k supps)
When should you treat a patient with stage 1 hypertension?
Stage 1=clinical BP of +140/90 in clinical setting and +135/85 ambulatory/home BP monitoring. Treat patient under 80 and have target organ damage (LVH, CKD, HT retinopathy) CV disease, renal disease, diabetes, 10 year cv risk >20%. Absence of these conditions advise lifestyle changes and review annually.
When should you treat a pt with stage 2 HT?
Stage 2=clinic blood pressure 160/100, +160/90 ambulatory/home monitoring, treall all pts.
