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Clinical 4th Year > Chapter 3- Coagulation > Flashcards

Chapter 3- Coagulation Flashcards

1
Q

Name three major parts of haemostasis

A

Vasospasm
Platelet plug formation
Coagulation

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2
Q

Give an overview of vasospasm in haemostasis

A

Damaged artery, collagen exposed, contract to prevent blood gushing out

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3
Q

Give an overview of platelet plug formation in haemostasis

A

Platelet adhesion to injured site

Platelets release adenosine biphosphate, serotonin and prothrombin A2 recruiting more platelets to site = plug formation

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4
Q

Give an overview of the coagulation/clotting step of haemostasis

A

Intrinsic and extrinsic pathway lead to prothrombinase

Prothrombinase converts prothrombin to thrombin, thrombin converts fribrinogen to fibrin

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5
Q

How is the clot broken down once damaged is healed

A

Healing and fibrolysis

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6
Q

During fibrinolysis what does the endothelium release and what does it convert?

A

Release tPA

Concerts plasminogen to plasmin

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7
Q

Plasmin cleaves X-linked fibrin polymer into what eventually?

A

D-D (d-dimer) and E

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8
Q

Deficiency in what 3 anticoagulants can increase someone’s risk of VTE?

A

Antithrombin
Protein C
Protein S

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9
Q

Name two abnormal proteins that can increase someone risk of VTE

A

Factor V Leiden

Fibrinogen (dysfibrinogenaemia)

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10
Q

List two procoagulants that can increase someone’s risk of VTE

A

Prothrombin 20210

Factor VIII

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11
Q

Abnormal metabolism of what can increase someone’s risk of VTE

A

Hyperhomocysteinaemia

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12
Q

List three LMWH

A

Dalteparin
Enoxaparin
Tinzaparin

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13
Q

What are the high, moderate and low scores in the wells pre-test probability of DVT

A

High: >2
Moderate: 1-2
Low: <1

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14
Q

What are the high moderate and low scores in the wells pre test probability of PE

A

High: >6
Moderate: 2-6
Low: <2

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15
Q

Which heparin is preferred for patients in renal failure?

A

Unfractionated heparin

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16
Q

How do you manage VTE in pregnancy

A

Heparins are used as they don’t cross the placenta

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17
Q

Which type of heparin in preferred in pregnancy?

A

LMWH because it has a lower risk of osteoporosis and of heparin induced thrombocytopenia

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18
Q

Name a reversal agent for heparin

A

Protamine

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19
Q

If a patient who has had a hip replacement is on DOAC then admitted to hosp with infection do they need VTE prophylaxis?

A

No as on DOAC

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20
Q

When using dalteparin in pregnancy to treat VTE what do you need to ensure the vial does not contain?

A

Benzyl alcohol

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21
Q

True or false and why: you can’t put in epidural unless the patient has not had heparin for 12hours

A

True due to bleeding risk

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22
Q

Pregnant lady has VTE .. what contraceptive can she have after birth?

A

POP not COC

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23
Q

Can you be in warfarin whilst breastfeeding

A

Yes

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24
Q

If having a C-section when should you stop LMWH

A

12-24hours beforehand

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25
Q

After birth when should you start LMWH and for how long

A

Start 12hours after birth for 10 days

26
Q

Can the wells score be used in pregnancy

A

No

27
Q

Is the D-dimer test useful in pregnancy

A

No high rate of false positives

28
Q

Is warfarin contraindicated in pregnancy?

A

Yeh

29
Q

What is heparin and how does it work?

A

Glycosaminoglycan: pentasaccharide sequence binds to lys and arg on AT producing a conformational change which increases AT activity

30
Q

What factors does AT inhibit

A

Factor 11, 9, 10 and thrombin

31
Q

Differences between UFH and LMWH

A

LMWH has less effect on thrombin and obvs a lower molecular weight, LMWH is s/c only whereas UFH is IV and s/c, LMWH is renally excreted only whereas UFH is renal and hepatic

32
Q

What’s the half life of LMWH

A

4-5 hours

33
Q

What’s the half life of UFH

A

60mins

34
Q

What monitoring is required for UFH

A

APTT: activated partial thromboplastin time

35
Q

When using APTT what is the normal range for time to clot? And what does APTT principally reflect

A

28-36seconds

Reflects anti-IIa activity

36
Q

What is used to monitor LMWH

A

Anti-factor Xa assay

37
Q

List 3 complications of UFH use

A

Under/overdosage
Osteoporosis
Heparin-induced thrombocytopenia

38
Q

What is heparin induced thrombocytopenia

A

Platelet activating autoantibodies to heparin-PF4 complexes

39
Q

When should you be alert to potential HIT

A

If platelet count falling

40
Q

Name the vitamin K dependent coagulation factors

A

9, 10, 7

41
Q

What does warfarin inhibit

A

Vitamin K epoxide reductase

42
Q

What’s the best method of monitoring warfarin

A

Prothrombin time then INR= prothrombin time/ geometric mean of normal prothrombin time

43
Q

When should you consider giving vitamin K in warfarin overdose?

A

INR >8

44
Q

Name two hirudins

A

Argatroban

Desirudin

45
Q

Name a synthetic heparin like molecule

A

Fondaparinux

46
Q

Name a direct anti-IIa inhibitor

A

Dabigatran

47
Q

Name three direct anti-Xa inhibitors

A

Rivaroxaban
Apixaban
Edoxaban

48
Q

List 4 advantages of the NOACs

A

Oral
Reproducible PK
Rapid onset
No monitoring required

49
Q

When should you take care with using NOACs

A

Peri-operative anticoag
Epidural anaesthesia
Renal impairment
Weight <50kg or >120kg

50
Q

How can you reverse rivaroxaban and dabigatran

A

Prothrombin complex concentrate

51
Q

What is andexanet alpha

A

Modified anti-FXa variant/decoy (rivaroxaban, apixaban, edoxaban bind to it instead of factor Xa)

52
Q

Name 4 thrombolytic agents

A

Streptokinase
rt-PA, alteplase
Reteplase
Tenecteplase

53
Q

What condition is a definite indication of using thrombolysis for acute DVT

A

Phlegmasia coerulea dolens

54
Q

List 10 contraindication of using fibrinolysis in acute MI

A 
Recent haemorrhage 
Trauma 
Surgery
Coagulation defects
Peptic ulceration 
Severe hypertension 
Acute pulmonary disease 
Acute pancreatitis 
Severe liver disease
Previous allergic reaction
55
Q

List risk factors for VTE

A 
Active cancer/cancer treatment 
Age >60
Dehydration 
Known thrombophilias 
Obesity >30 bmi
Comorbidities (heart disease, metabolic, endocrine, respiratory, infection, inflammation) 
Personal history/family 
HRT
COC
Varicose veins with phlebitis
56
Q

When should you reassess patients risk of bleeding and VTE

A

Within 24 hours of admission and whenever clinical situation changes

57
Q

Should you offer anti-embolism stockings for VTE prophylaxis in stroke patients

A

No

58
Q

Advice on VTE prophylaxis in surgical patients

A

Stop COC and HRT 4 weeks before elective surgery

59
Q

What is the INR target in someone on warfarin with a mechanical heart valve

A

3.5

60
Q

INR target of someone on warfarin with recurrent DVT

A

3

Clinical 4th Year (9 decks)

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