Blood Flashcards by Yuko Porter

Thrombotic States 5 血栓性

Venous thromboembolism (VTE)
Pulmonary embolus (PE)
Thromboembolic stroke
Transient ischemic attack (TIA)
Acute coronary syndrome (ACS)

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What are 3 major cause of blood clot?

-Hypercoagulable
(pregnancy, cancer, disease)
-Endothelial injury
-Circulator stasis

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What is hemostasis?

the stopping of a flow of blood.

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Process of hemostasis

Injury to a blood vessel
then Blood vessel constriction
then Platelet plug formation
then Blood coagulation

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Anticoagulation
action?

Prevent for further clot

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Anticoagulation
Prophylactic action 3

Prevent fibrin deposits
Limits thrombus extension
Prevent thromboembolic complications

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Anticoagulation
No direct effect on clots (doesn’t break them down)
So how does it work on clots that are already formed?

Induce the body’s response (plasmin) to break it down.
This is why we use anticoagulants on active DVTs.
Safer way to destroyed clot is natural body response

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Heparins
agents

Unfractionated heparin (UFH)
**most common

Low molecular weight heparins (LMWH)
-Enoxaparin
-Dalteparin Estimate Deliver Time
-Tinzaparin “parin”

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Unfractionated Heparin
a) Half-life
b) onset
c) excretion

Most common
a) 1-2 hr
b) immediate when used IV
c) Non-renal
Heparin breaks down everywhere, so not pee out

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Unfractionated Heparin
What must need with this med?

Monitored by aPTT
wide range pf responses that differ with every pt
Too much coagulation= bleeding
Too little coagulation=clots

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Unfractionated Heparin
reversal agent

protamine sulfate

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Low Molecular Weight Heparin
a) Chemically consists?
b) Administered by

a) short-chains of polysaccharides
b) subcutaneous injection

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Low Molecular Weight Heparin
a) Half-life
b) onset
c) excretion

a) 3-6 hours
b) 3-5 hours
Not for emergency
c) renal

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Low Molecular Weight Heparin
Is this need monitor?

NO!
It is a predictable, pt response doesn’t vary

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Heparin
ADRs

Bleeding
–Much less with LMWH
Thrombocytopenia
Hypersensitivity reactions

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What is Thrombocytopenia?

Can lead HIT!
Don’t give heparin with HIT pts because all platelets are utilized
Monitor platelet count!

HIT= (heparin-induced thrombocytopenia)

Thromb=platelet
penia=little

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LMWH Advantages

Predictable dosing/response
Safe outpatient treatment
Less bleeding
No need for routine laboratory monitoring

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Fondaparinux

Found parin ux

Chemically related to the LMWHs
Administer SUQ
Causes less HIT
only for HIT pt who cannot take heparin
it is a pentasaccharide

Argatroban
a) action?
b) indication?
c) reversal agent?

a) Direct thrombin inhibitor
b) Indicated for use in patients with HIT
Monitored by aPTT
c) Reversal agent – andexanet alpha

Warfarin
a) route?
b) action?
c) Reversal agent

a) Oral administration
b) Block production of vitamin K-dependent clotting factors
c) vitamin K

Warfarin
a) indication
b) contraindication

a) DVT
valve replacement,
atrial fibrillation,
AMI( heart attack)
b)pregnancy

Adjust dose to INR at 1.2-2.5 times control

Warfarin
Pt education
a) what needs?
b) Drug interaction

a) regular INR monitoring
Consistent levels of activity
(don’t excise too much to change metabolize)
b) alcohol, aspirin, ibuprofen
herbal and OTC use, clear with a healthcare provider
Aspirin + Warfarin = bad bleeds

Warfarin
Pt education
a) dietary modifications

a) No fad diets
Consistent vit k consumption
Consistent levels of activity
Need for medical alert bracelet/ID card

Monitor for Over-Anticoagulation 5

Unexplained nosebleeds
Bleeding gums
Blood in urine
Blood in stool
Easy bruising

Direct Thrombin Inhibitors

Dabigatran

Dabigatran Da(me) bigatran a) action b) DO NOT ....?

a) Oral direct thrombin inhibitor –Bioavailability 3-7% b) Big increase if capsules opened, must be swallowed whole DO NOT open the capsules FDA-approved in 2010

Dabigatran a) Elimination where? b) Reversed with?

a) renal No routine efficacy monitoring needed b) idarucizumab

Xa Inhibitors agents

Rivaroxaban Apixaban Edoxaban xban

Xa Inhibitors ADRs

Bleeding Dyspepsia　　消化不良 kind of chronic indigestion 消化不良 Must adjust doses in renal insufficiency

Anticoagulation Cautions 4

Elderly ID bracelet Drug interactions Severe consequences

Aspirin a) action b) indication

a) Inhibit platelet aggregation by inhibiting the production of thromboxane b)Used as secondary prophylaxis of heart attacks, strokes, and blood clots in patients at increased risk Secondary means pt already had a such health issue

Aspirin a) 75-81 mg per day use for? b) ADRs

a) Lower dose than for use as analgesic/antipyretic b) GI bleeding(even with baby aspirin)

IIb/IIIa Inhibitors agents

Abciximab eptifibatide tirofiban

IIb/IIIa Inhibitors a) action b) indication c) ADRs

a) Inhibit platelet aggregation by preventing the binding of adhesion ligands to the GP IIb/IIIa receptor on the platelet. b)during the percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS) c) Bleeding Injection ONLY

Thrombolytics a) action b) indication

a) dissolve clots by activating plasmin b) myocardial infarction pulmonary embolism deep vein thrombosis stroke? We use this for emergencies!!!! We need to destroy the clot RIGHT NOW!!

Thrombolytics agents

alteplase anistreplase reteplase streptokinase urokinase Clot buster!

Thrombolytics Contraindications

aneurysm　動脈瘤 active bleeding brain tumor stroke, CNS surgery within last 2 months severe uncontrolled HTN trauma A lot, that is why we don't give this

Thrombolytics Complications

bleeding allergy anistreplase streptokinase

Blood transfusion a) Packed red blood cells b) Washed red cells

a) prevent circulatory overload b) decrease chance of allergy

Blood transfusion a) Fresh frozen plasma b) Albumin

a) Provide clotting factors b) volume expansion

Blood transfusion Complications

Hemolysis Allergic reaction Febrile reaction Bacterial, viral contamination Circulatory overload

Is Enoxaparin need monitor?

no LMWH

Indicated for use in patients with HIT

Argatroban Fondaparinux less HIT side effect