Coags and Anticoags

Question 1

Heparin Class

Answer 1

Anticoagulant

Question 2

Heparin Use

Answer 2

DVT prophylaxis, PE, and acute coronary syndrome

Question 3

Heparin MOA

Answer 3

Binds with antithrombin 3 which increases its activity 1,000

• Inhibits thrombin (factor 2a) and factor Xa
• Depresses factors 9a, 11a, and 12a (IXa, XIa, and XIIa)

Question 4

Heparin Dose

Answer 4

5,000 units SQ for DVT prophylaxis

Question 5

Heparin Pharmacokinetics

Answer 5

Onset = immediate 
DOA = 3 - 6 hours 
Metabolism = liver 
Elimination = heparin protamine complexes eliminated via reticuloendothelial system

Question 6

Heparin Contraindications

Answer 6

DIC, thrombocytopenia, intracranial bleed

Question 7

Heparin Considerations

Answer 7

Check PTT levels
Can cause HIT
Bleed risk

Question 8

Protamine Class

Answer 8

Heparin antidote

Question 9

Protamine Use

Answer 9

Reversal of Heparin

Question 10

Protamine MOA

Answer 10

Combines with heparin to form inactive compound without anticoagulant effects

Question 11

Protamine Dose

Answer 11

Based on amount of heparin given
1 mg per 100 units of heparin
Give under 5mg/min (risk of anaphylaxis if pushed too fast)

Question 12

Protamine Pharmacokinetics

Answer 12

Onset = 5 min
DOA = 2 hours
Half life is shorter than heparin, concern for rebound bleeding
Metabolism & Elimination = reticuloendothelial system

Question 13

Protamine Contraindications

Answer 13

Pulmonary HTN and fish allergies

Question 14

Protamine Considerations

Answer 14

Severe hypotension with rapid admin, flash pulmonary edema, and allergic reactions can occur

Releases histamine 
Pulmonary hypertension 
Circ collapse 
Facial flushing 
Bronchoconstriction

Question 15

Tranexamic Acid Class

Answer 15

antifibrinolytic agent

Question 16

Tranexamic Acid Use

Answer 16

given IV to prevent or reduce bleeding and the need for transfusion

Question 17

Tranexamic Acid MOA

Answer 17

Prevents fibrinolysis by reversibly inhibiting the lysine receptor on plasminogen preventing plasmin from breaking down clot→ keeps clot intact

Question 18

Tranexamic Acid Dose

Answer 18

1 gram over 10 min
May repeat 1 g during next 8 hours
Max 2g

Question 19

TXA Pharmacokinetics

Answer 19

Onset = ?? 
DOA = 3 hours 
Metabolism = small portion by liver 
Elimination = renal (large portion unchanged)

Question 20

TXA Contraindications

Answer 20

Allergy to TXA
Intracranial bleeding
Pre-existing clotting disorder, history of CVA
Recent MI and stent placement

Question 21

TXA Considerations

Answer 21

Rapid infusion may cause hypotension