Coagulation/Anticoagulation Flashcards

1
Q

What are 4 categories of coagulation agents?

A
  • antiplatelets
  • anticoagulants
  • thrombolytics
  • procoagulants
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2
Q

What are the 4 steps of hemostasis?

A
  1. vasoconstriction
  2. platelet plug
  3. clot formation
  4. clot dissolution
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3
Q

Normally, vascular endothelium provides a ____ surface. “__” “___” “___”

A

nonthrombogenic

  • antiplatelet
  • anticoagulant
  • profibrinolytic
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4
Q

What factors are dependent on Vitamin K?

A

Factors 2, 7, 9, 10

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5
Q

Where is tissue plasminogen activator (t-PA) released from? (4)

A

tissue, vascular endothelium, plasma, urine (urokinase)

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6
Q

What does plasmin do?

A

digests fibrin…. pg 22

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7
Q

Are older or new clots easier to break?

A

new; weak cross-linking in fibrin

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8
Q

What does plasminogen become?

A

plasmin

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9
Q

How is plasmin formed?

A

from plasminogen being activated

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10
Q

What factor is antithrombin?

A

factor 3

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11
Q

What does factor 3 (antithrombin) do?

A

inactivates factor IIa, Xa

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12
Q

What medication works with factor 3 (anti-thrombin)?

A

HEPARIN

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13
Q

What is Warfarin?

A

Coumadin; Vitamin K antagonist

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14
Q

What is Coumadin?

A

Warfarin; Vitamin K antagonist

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15
Q

What factors are targeted by Warfarin?

A

Factors 2, 7, 9, 10

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16
Q

If a patient on Coumadin is bleeding do you give platelets? Why?

A

No, they have working platelets

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17
Q

Onset of Coumadin

A

Warfarin;

3-4 days

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18
Q

If a patient is on Warfarin, what lab needs to be checked pre-op?

A

PT/INR

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19
Q

For minor surgery, when should Coumadin be stopped?

A

1-5 days pre-op; goal is PT within 20% of baseline

20
Q

What is in FFP?

A

coagulation factors?

21
Q

When do you give FFP?

A

when a coumadin patient is bleeding (gives factors)

22
Q

What naturally releases heparin?

A

mast cells & basophils

23
Q

What does heparin do?

A

ENHANCES factor 3

24
Q

Is heparin lipid soluble?

A

NO - don’t give oral

25
Does heparin cross placenta?
NO; it is SAFE
26
Can coumadin be given in pregnancy?
NO! teratogenic - give heparin instead
27
How long does the action of heparin last?
1.5-4 hours
28
What destroyes heparin?
heparinase (enzyme in the blood)
29
ACT normal is what?
80
30
Heparin will prolong what lab value?
ACT
31
What is a normal aPTT?
30-35 seconds
32
What is a normal aPTT in heparin therapy?
1.5-2.5 times pre-drug level
33
Goal ACT in vascular or non-CPB cases?
>200-300 seconds
34
Goal ACT in interventional aneurysm clipping/coiling?
>250
35
ECMO / CPB ACT goal?
>400 seconds
36
What will reverse heparin?
Protamine or FFP
37
What is the dose of protamine?
1-1.5mg for each 100u of heparin
38
What does factor X do?
catalyzes the conversion of prothrombin to thrombin
39
Does protamine neutralize/reverse Lovenox?
NO, give FFP
40
What are the two categories of direct oral anticoagulants?
1. direct thrombin (IIa) inhibitor | 2. direct factor Xa inhibitor
41
What is a direct thrombin (IIa) inhibitor?
Dabigatran - Pradaxa
42
What is the reversal to Dabigatran/Pradaxa?
Idrucizumab (PRAXBIND)
43
What are direct factor Xa inhibitors?
- Rivaroxaban (Xarelto) - Apixaban (Eliquis) - Edoxaban (Savaysa)
44
What is PCC?
prothrombin complex concentrates
45
What are 3 targets of platelet supression?
1. COX/TXA2 inhibition 2. ADP receptor antagonism 3. GP IIb/IIIa receptor antagonism