Bleeding Disorders

Question 1

TXA

A, D, M, E

&

Dose /Route

Answer 1

A = Parenteral
D = 3% Bound Plasminogen 
M = Liver
E = Urine 

Dose:

1g IV/IO over 10 minutes.

Question 2

TXA

Indications and Contra-Indications

Answer 2

Indications:

• Time critical injury with known/suspected internal/external bleed.
• Meeting stage 1 or 2 of Major trauma tool.
• PPH if haemorrhage continues post Misoprostol.

Contra-Indications:

• Known allergy.
• Obvious haemorrhage resolution.
• Known history of convulsions.
• Critical interventions required.
• PPH prior to uterotonic, unless trauma cause.

Question 3

TXA

Action

Answer 3

anti-fibrinolytic

• Competitive inhibitor of plasminogen.
• Binds to Lysine receptor sites in Kringle Domaine.
• Prevents plasminogen converting to plasmin.
• Thus maintains thrombus fibrin strands.

Question 4

Aspirin

Action

Answer 4

Anti-platelet

• Antagonist
• Inhibits Cyclo-Oxygenase (COX) preventing Prostaglandin synthesis.
• Thus prevents Prostaglandin producing Thromboxane A2, which activates platelet synthesis.

Question 5

Aspirin

Indications and Contra-Indications

Answer 5

Indications:

• Clinical or ECG evidence suggestive of MI or Ischaemia.

Contra-indications:

• known Allergy.
• Under 16.
• Active GI bleed.
• Severe Hepatic disease with jaundice.
• Haemophilia or other known clotting disorders.

Question 6

Aspirin

A, D, M, E

&

Dose /Route

Answer 6

A - Enteral.
D - plasma proteins.
M - Liver.
E - Urine.

Dose:

300mg PO

Question 7

Clopidogrel

Action

Answer 7

Anti-Platelet

• Adenosine Triphosphate (ADP) selective Antagonist.
• Preventing ADP binding to platelet receptors =
  • Prevents further platelet aggregation.
  • Inhibits fibrin cross linking (via Glycoprotein 11b/11a).

Question 8

Clopidogrel

Indications and Contra-indications

Answer 8

Indications:

• Acute STEMI
  (• In pts not taking Clopidogrel)
  (• In pts receiving thrombolytic meds)
  (• Anticipated thrombolytic or PPCI)

Contra-indications:

• Known allergy.
• Known severe liver impairment.
• Active pathological bleed (e.g. peptic ulcer or inter-cranial bleed).

Question 9

Clopidogrel

A, D, M, E

&

Dose /Route

Answer 9

A - Enteral
D - Plasma Proteins
M - Liver
E - Urine

Dose:

300mg PO if for Thrombolysis.
600mg PO if for PPCI.

Question 10

Tenecteplase

Action

Answer 10

Fibrin Specific Fibronolytic

• Binds to fibrin of a thrombus via fibronetic.
• Selectively converts plasminogen, into Plasmin.
• Degrades fibrin mwah of thrombus = breaks clot.

Question 11

Tenecteplase

Indications and Contra-indications

Answer 11

Indications:

Acute STEMI within 6hrs onset and PPCI not available.

Contra-indications:

• Follow Checklist.

Question 12

Reteplase

Action

Answer 12

Thrombolytic (Fibrinolytic)

• Glycoslated Human tissue plasminogen (tPA) activator.
• Assists Plasminogen to synthesise plasminogen, which breaks down fibrin strands of thrombus.
• Reteplase binds time fibrin cloys via fibronectin and Kringle domain.

Question 13

Reteplase

Indications and Contra-indications

Answer 13

Indications:

• STEMI - less than 12hrs from onset & PPCI unavailable.

Contra-indications:

• Per checklist.

Question 14

Heparin

Action

Answer 14

Anti-coagulant

• Accelerates rate of anti-thrombin production.
• Agonist, binding to anti-thrombin III.
• Inhibits clotting factor Xa, preventing thrombin activation from pro-thrombin.
• Also inhibits thrombin, activating fibrinogen.

Question 15

Heparin

Indications and contra-indications

Answer 15

Indications:

• STEMI in conjunction with Reteplase or Tenecteplase.

Contra-indications:

• see JRCALC.