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IHO Week 6 > Clinical Aspects of Coagulation > Flashcards

Clinical Aspects of Coagulation Flashcards

1
Q

What does fresh frozen plasma (FFP) have?

A

Have everything in Cryoprecipitate

  • All coagulant factors in normal levels
  • May reverse warfarin effect or replace factors missing due to liver disease or DIC
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2
Q

What is Cryoprecipitant?

A
  • 1U equal to cold-induced precipitation of 10U FFP

- Provides fibrinogen, vWF, factor VIII, factor XIII, fibronectin

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3
Q

What is the best way to initiate anti-coagulation?

A
  • UFH plus warfarin x 4-5 days, then warfarin mono therapy

- LMWH plus warfarin x 4-5 days, then warfarin mono therapy

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4
Q

What does a patient have to be on both heparin and warfarin for 4-5 days?

A

Requires 4-5 days of warfarin to fully affect prothrombin (factor II)

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5
Q

What happens if a shorter induction course of warfarin is used?

A

20 mg daily for 1 day and the INR is therapeutic

  • Is this OK?
  • –Absolutely contraindicated
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6
Q

What factors are required for hemostasis?

A
  • Platelets
  • Procoagulant factors (clotting cascade)
  • Anti-coagulant factors (Protein C, Protein S, anti-thrombin III, tPA)
  • Intact vasculature
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7
Q

What is hemostasis?

A

Dynamic interaction between vascular endothelium, platelets, procoagulant factors and anticoagulant factors

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8
Q

What is normal platelet count?

A

150-400K

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9
Q

What happens if the platelet count is 25K?

A

Probably nothing

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10
Q

What happens if the platelet count is

A

Increased risk of mucocutaneous bleeding and CNS hemorrhage

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11
Q

What is more important than the actual number of platelets?

A

Platelet surface are is more important

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12
Q

What is the most common reason for impaired platelet function?

A

ASA (aspirin)

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13
Q

What happens with NSAIDs?

A

Usually nothing. NSAIDs have reversible platelet inhibition.

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14
Q

What is PT/INR?

A

Prothrombin Time
INR = International Normalized Ratio
(Measured PT/Control PT)^ISI = INR
-The assay used to measure WARFARIN efficacy
-Target INR 2.0-3.5, depending on clinical circumstance

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15
Q

What is aPTT?

A
  • Activated partial thromboplastin time
  • The assay used to measure HEPARIN efficacy
  • -Unfractionated heparin
  • -NOT low-molecular weight heparin
  • -Also used to measure effects of argatroban and leparudin
  • Therapeutic range 60-80 seconds
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16
Q

What is the Chromogenic Xa assay?

A
  • A way to measure HEPARIN levels
  • Can use a variant of this assay to measure warfarin efficacy if INR is unreliable
  • Useful with the presence of a lupus anti-coagulant or anti-phospholipid antibody
17
Q

What is PFA-100?

A
  • A useful way to measure platelet function.
  • Measures platelet response to ADP, collagen, epinephrine
  • Completely automated
  • Does not reveal etiology of platelet function defect
18
Q

What is bleeding time test?

A
  • Designed to measure platelet function
  • Laboratroy technician nicks forearm with razor and then touches the cut intermittently with filter paper
  • Keep doing this until the bleeding stops (normal
19
Q

How does Aspirin work?

A
  • Irreversible acetylation of platelets
  • Aspirin effect lasts for up to 10 days
  • How do you reverse aspirin? TIME & Platelet transfusion
20
Q

What are NSAIDS?

A
  • Ibuprofen, naproxen sodium, ketorolac, sulindac, indomethacin
  • REVERSIBLE effect on platelet function
  • Effects reversed within 6-8 hours
21
Q

What is Warfarin?

A
  • Most common anticoagulant
  • Interferes with VitaK dependent secondary glycosylation of factors II, VII, IX, X
  • Dosed according to INR
  • Target INR 2-3 for DVT/PE
  • Target INR 2.5-3.5 for mechanical heart valve
  • How to reverse warfarin? VitaK, Time, Fresh frozen plasma
22
Q

What should you know about Heparin?

A 
Unfractionated Heparin (UFH)
-UFH with unpredictable absorption
-May be administered IV or SQ
-Dosage based on body weight
-Need to follow (often daily) aPTT
LMWH (enoxaparin)
-Extremely reliable absorption
-SQ administration
-No need to monitor levels
-Expensive ($70-$100/day)
23
Q

How does tPA act?

A

Direct fibrinolysis

-Used with MI, Stroke, PE

24
Q

How does Vitamin K act?

A
  • Reverses Warfarin

- May be helpful with coagulopathy of liver disease

25
Q

What’s DDAVP?

A
  • Increases vWF production by vascular endothelium
  • Von Willebrand’s disease
  • Uremic platelet dysfunction
26
Q

What do you see in Vascular/Platelet defects?

A
  • Prolonged bleeding
  • Petechiae & easy bruising
  • Skin and mucus membranes
  • Non-recurrent bleeding
27
Q

What do you see in Coagulation Defects?

A
  • Prolonged bleeding
  • Deep hematomas
  • Hemarthrosis
  • Recurrent bleeding
28
Q

What are petechiae a sign of?

A

Thrombocytopenia (low platelets!)

29
Q

What are hyper coagulable states/thrombosis?

A
  • Post-operative state
  • Malignancy
  • Immobilization
  • Pregnancy/Estrogen Use
  • Oral contraceptives/smoking
  • Previous venous thromboembolism
  • Hereditary Hypercoagulable states
  • –Factor V Leiden
  • –Antiphospholipid antibody
  • –Prothrombin gene mutation
  • –Idiopathic

IHO Week 6 (16 decks)

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