coagulation Flashcards
first line of defense against bleeding
vasoconstriction
key mediator of vasoconstriction in response to endothelial damage
endothelins (proteins released by endothelial cells)
coagulation factors are synthelized in the
liver
coagulation factors form
fibrin
coagulation factors circulate as
zymogens
many coagulation factors active to become
serine proteases
center of coagulation cascade is activation of
X to Xa
Xa converts
prothrombin to thrombin
thrombin converts
fibrinogen to fibrin
Xa inhibitors
rivaroxaban
apixaban
direct thrombin inhibitors
hirudin
lepirudin
bivalirudin
desirudin
argatroban
dabigatran
major activator of coagulation system
tissue factor
primary event causes
exposure of tissue factor
tissue factor interacts with
VII and activates it
tissue factor and VIIa activate
X to Xa
thrombin makes more
thrombin and acts as positive feedback for the cascade
defects in factors IX and VIII cause
hemophilia (cant amply clotting cascade which causes bleeding)
factor VIII circulates bound to
von Willebrand factor (which increases half life)
factor VIII is produced in
endothelial cells
multicomponent complexes are three components bound together including
- active clotting factor
- co factor
- substrate
multicomponent complexes require
phospholipids and calcium
extrinsic Xase (multicomponent complex) enzyme
VIIa
intrinsic Xase enzyme
IXa
calcium is required for
clot formation
role of factor XIII
crosslinks fibrin stabilizing the plug
factor XIII requires what as a cofactor
calcium
XII is activated by
contact with negative charges (silica)
basis for partial thromboplastin time
factor XII
intrinsic pathway requires
kinins
kinins link
coagulation with inflammation
bradykinin
vasodilator
bradykinin is degraded by
ACE & C1 inhibitor
C1 inhibitor deficiency causes
hereditary angioedema
factor XII activates
clotting and produces bradykinin
prekallikrein deficiency results in
markedly prolonged PTT
in prekallikrein deficiency __ cannot activate the clotting cascade normally
XII
kinin system activated by
factor XII
imp deactivators of coagulation
antithrombin III
protein C and S
tissue factor pathway inhibitor
antithrombin III is a
serpin (inhibitor of sarin proteases)
antithrombin III inhibits
II, VII, IX, X, XI, XII
antithrombin III is the basis for
heparin drug therapy
deficiency antithrombin III causes
hypercoagulable state
protein C and S are
glycoproteins synthesized in liver
activated protein C inactivates factors
Va and VIIIa
protein C activated by
thrombomodulin
thrombomodulin binds
thrombin and then activates protein C
activated protein C requires
protein S as a co factor
tissue factor pathway inhibitor inactivates
Xa
tissue factor pathway plasma levels increased with
heparin administration
plasminogen is synthelized by
liver
plasminogen is converted to
active enzyme plasmin
main role of plasmin
breakdown fibrin
plasminogen activators
tissue plasminogen activator & urokinase
fibrin is broken down into
fibrin degradation products & D dimer
presence of D dimer indicates
clot breakdown
fibrinogen degradation products indicate
plasmin activity only
primary fibrinolysis is a rare phenomena in which
plasmin is overactive
primary fibrinolysis causes
increased fibrin degradation products with normal D dimer
plasmin can deplete
clotting factors
clot breakdown causes
fibrinogen degradation products and dimers
hyperfibrinolysis causes
fibrinogen degradation products and normal dimers
vitamin K is required for
syntheisis of clotting factors II, VII, IX, X, C, S
warfarin is a
vit k antagonist
erythrocyte sedimentation rate is increased in
inflammatory conditions