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T year ann Battersby week > Clinical anticoagulants > Flashcards

Clinical anticoagulants Flashcards

1
Q

Why are platelets important for clotting?

A

They provide the phospholipid surface
Contain clotting factors
binds collagen, vWF and fibrinogen

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2
Q

What is the structure of serine proteases?

A

They have a GIa domain which is hydrophobic to bind to the phospholipid surface

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3
Q

what are some serine proteases?

A

Clotting factors II,VII,FIX,X

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4
Q

in brief how is the fibrin strand produced?

A

Prothrombin is converted to thrombin by FX.

thrombin can then convert fibrinogen to fibrin.

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5
Q

what are some indications for anticoagulation?

A
  • AF
  • Valvular heart disease
  • cardiomyopathy
  • VTE
  • MI
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6
Q

what factors does the CHAD 2 score take into account?

A 
CHF
hypertension
Stroke/TIA
Age>75
Diabetes 
valvular disease
female
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7
Q

what factors does HASBLED take into account?

A
  • hypertension
  • abdominal, renal or liver dysfunction
  • Stroke
  • Bleeding
  • INR
  • eldery
  • drugs/ alcohol
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8
Q

using the CHAD system who gets anticoagulants?

A

all men with a score of 1

anyone with a score of 2

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9
Q

why can factor 8 increase after surgery?

A

its an acute phase reactant

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10
Q

what are absolute contraindications of anticoagulants?

A

Acute bleedings

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11
Q

what are relative contraindications of anticoagulation?

A 
Active peptic ulceration
alcohol or drug use
poor compliance
severe liver disease
renal impairment
uncontrolled hypertension
dementia
pregnancy
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12
Q

what is unfractionated heparin?

A

a linear sulphated polysaccharide consisting of negatively charged glycosaminoglycans with a 1;1 raio of anti X and anti II

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13
Q

what is low molecular weight heparin?

A

Has differing Anti X and anti II ratio’s

produced by depolymerisation of unfractionated heparin

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14
Q

how is heparin produced?f

A

from bovine lung/ porcine intestine

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15
Q

what is the MOA of heparin?

A

it binds to anti thrombin causing a conformational change, this increases the inhibiton of FX and thrombin

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16
Q

how is unfractionated heparin cleared?

A

reticuloendothelial

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17
Q

what is the half life of unfractionated heparin?

A

1.5 hours

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18
Q

how is unfractionated heparin given?

A

IV or sc

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19
Q

what is the reversal for unfractionated heparin?

A

protamine

20
Q

how is LMWH cleared?

A

renal

21
Q

what is the half life of LMWH?

A

12 hours

22
Q

what is the amount of time before LMWH is peak?

A

3-4hours

23
Q

how is LMWH administered?

A

Sc

24
Q

what is the reversal for LMWH?

A

minimal reversal can be achieved with protamin

25
Q

what people need anti Xa monitoring?

A

Pregnant people
renal impairment
Obesity

26
Q

what tests will unfractionated heparin effect?

A

APTT

27
Q

What tests will LMWH effect?

A

Anti Xa

28
Q

what tests will vitamin K antagonists affect?

A

PT/INR

29
Q

what tests will dabigatren affect?

A

TT

30
Q

what are the side effects of heparin?

A
  • bleeding
  • thrombocytopenia
  • osteoporosis
31
Q

what do you do for heparin induced thrombocytopenia with thrombosis?

A

stop heparin and given danaparoid or hirudin

32
Q

how does warfarin work?

A

Its a vitamin K antagonist

33
Q

What process does vitamin K interfer with?

A

gamma carboxylation of GIa domain

34
Q

what does gamma carboxylation of the GIa domain normally allow?

A

interaction with the phospholipid of platelet membranes which localises coagulation

35
Q

how is warfarin initiated in patients with thrombosis?

A

with heparin

36
Q

what is warfarin dose sensitive to?

A

diet
drugs
ethnicity
age

37
Q

what test is warfarin monitored with?

A

INR/PT

38
Q

For warfarin VTE prophylaxis what INR is ideal?

A

2-2.5

39
Q

For people on warfarin due to mechanical heart valves what INR value is ideal?

A

3-4

40
Q

for people on warfarin due to antiphospholipid syndrome what INR is a good range?

A

2.5-3.5

41
Q

what are the side effects of warfarin?

A

Bleeding, skin necrosis, birth skeletal abnormalities, increased foetal loss

42
Q

what does warfarin cause skin necrosis?

A

Due to a protein C deficiency

43
Q

what does warfarin cause birth skeletal abnormalities

A

Lack of gamma carboxylation of bone protein takens place

44
Q

how do DOAC’s work?

A

targeted inhibition of Xa or thrombin

45
Q

what tests can be done to monitor dabigatran?

A

aPTTR

46
Q

what does a normal TT mean in dabigatran?

A

It excludes the possibility that there is any circulation

47
Q

what is the reversal agent for dabigatran?

A

idarucizumab

T year ann Battersby week (4 decks)

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