Blood: Fibrinolytics

Question 1

Serine protease catalysed from its zymogen precursor

Answer 1

Plasmin from plasminogen catalysed by fibrinolytics
This lyses tye thrombi

Question 2

Generalised lyrics state

Answer 2

With IV fibrinolytics

Question 3

Goal of early fibrinolytics

Answer 3

Clot dissolution and reperfusion

Question 4

When to give fibrinolytics

Answer 4

Give IV
Multiple venous emboli
Central DVT
Acute MI
Give IArterial
Peripheral Vascular Diseases

Question 5

Adverse effect of fibrinolytics

Answer 5

Bleeding

Question 6

Treat bleeding with

Answer 6

Tranexamic acid
Fresh plasma
Coagulation factors

Question 7

Streptokinase

Answer 7

Protein synthesised From srmtrptococci

Question 8

Combines with coactivator plasminogen to form enzymatic complex

Answer 8

Streptokinase

Question 9

Systemic fibrinolytic

Answer 9

As streptokinase acts on plasmjnogen in both thrombus and plasma
Given IV

Question 10

Added streptokinase adverse effects

Answer 10

Allergy
Fever

Question 11

Urokinase

Answer 11

Human enzyme from urine of pregnant women
-synthesised by the kidney

Question 12

Anistreplase

Answer 12

Combo of strepto and proactivator plasminogen

Question 13

Tissue plasminogen activators- Alteplase and Reteplase

Answer 13

Recombinant DNA tech like
Recombinant like Andexanetalfa (for quasi factor 10a)

Question 14

Selective activation of thrombus plasminogen for LOCAL fibrinolytic effect

Answer 14

Alteplase and reteplase - IV

Question 15

No allergy with

Answer 15

Alte and reteplase

Question 16

Reteplase has

Answer 16

Longer half life so given as bolus

Question 17

Fibrinolytic inhibitors

Answer 17

Oral or IV aminocaproic acid and tranexamic acid

Question 18

Indications for fibrinolytics

Answer 18

Bleeding from fibrinolytic therapy
Adjunctive in hemophilia
Post prostectomy bleeding
Rebleeding in intracranial Aneurysms

Question 19

Intravascular thrombosis in fibrinolytic inhibitors

Answer 19

From inhibition of plasminogen activator

Question 20

Management of thromboembolic diseases

Answer 20

Venous and arterial thromboembolism

Question 21

Venous

Answer 21

DVT
DVT + pulmonary thrombolism

Question 22

DVT

Answer 22

Initial therapy - anticoagulant for the first 5 - 10 days
LMWH and Fondaparinux referred over UFH

Question 23

Combination therapy

Answer 23

Paranteral overlapping with oral (warfarin) for a minimum of 5 days to get to 2 -3×INR

Question 24

Maintenance of DVT

Answer 24

For at least 3 months:
Oral anticoagulant; warfatjn with monitoring of INR or rivaroxaban or apixaban

Question 25

Treatment of DVT with pulmonary embolism

Answer 25

Either hemodynamically stable (anticoagulant) or not (thrombolytics like Alteplase or streptokinase or uro(don't use))

Question 26

Give thrombolytics to patients with

Answer 26

Low risks of bleeding

Question 27

Maintenance of DVT with PE

Answer 27

Oral anticoagulants for 3 months too If coupled with cancer: LMWH for 3 to 6 months initially

Question 28

Prophylaxis of VTE

Answer 28

Especially high risk hospitalised patients - that'll make them bedridden: acute stroke, critically ill, decompensated HF

Question 29

More hospitalised patients at risk

Answer 29

Acute inflammatory bowel disease Surgical and orthopedic patients; abdominal-pelvic surgery for cancer, total hip or knee arthroplasty, fragility fractures, major trauma surgery, craniotomy, cardiac surgery Aortic Aneurysm repair Thoracic surgery with metastatic cancer

Question 30

Already coagulation Major bleeding Recent clinically bled Thrombocytopenia Inherited or acquired bleeding disorders

Answer 30

Absolute contraindications

Question 31

Prophylaxis drugs lower doses than treatment doses

Answer 31

Direct - Rivaroxaban and dabigatran LMWH - but avoided with renal impairment

Question 32

Heparin induced thrombocytopenia treated by

Answer 32

Stopping heparin (use direct anticoagulants for anticoagulation lie Argatroban

Question 33

Off label anticoagulants with HIT

Answer 33

Rivaroxaban Fondaparinux Used in place of heparin

Question 34

Arterial Thromboembolism

Answer 34

With MI or stroke

Question 35

Treatment of cerebral stroke

Answer 35

Alteplase - within 3 hrs for golden time Aspirin - within 48hrs

Question 36

Streptokinas not used

Answer 36

Produces antibodies so loses effectiveness and allergy

Question 37

Prophylaxis

Answer 37

75 to 100 mg aspirin once Add sustained release dipyridamolr And clopidogrel if intolerant

Question 38

Better to avoid aspirin combo

Answer 38

Because intracranial hemorrhage And check for the risk of thrombosis before prophylaxis