Coagulation Book - Cardiac Anesthesia ch 19

Question 1

Major ligand for platelet activation

Answer 1

Fibrinogen

Question 2

important ligand for platelet adhesion at low shear stress

Answer 2

vWF

Question 3

important ligand for platelet aggregation at higher shear stress

Answer 3

vWF

Question 4

Provides post feedback by activating Cofactors V and VIII

Answer 4

Thrombin

Question 5

Accelerates cross linking of fibrinogen by activating FXIII

Answer 5

Thrombin

Question 6

Activates Protein C, which provides neg feedback by inactivating FVa and FVIIIa

Answer 6

Thrombin

Question 7

Inactivates FVa and FVIIIa

Answer 7

Proteins C and S

Question 8

Inhibits initiation of extrinsic pathway

Answer 8

TF inhibitor

Question 9

Heparin’s pH status?

Answer 9

strong biologic acid

negatively charged at physiologic pH

Question 10

Heparin distribution is mainly in the ? (2)

Answer 10

intravascular space and endothelial cells

Question 11

Heparin eliminated by what?

Answer 11

kidneys of metabolism in reticuloendothelial system

Question 12

Heparin boluses can decrease what?

Answer 12

SVR

Question 13

The CPB priming solution should contain Heparin at what concentration?

Answer 13

approx the same conct as patients blood stream at onset of CPB

ex priming vol of 1500ml should contain 5000units heparin

Question 14

whole blood heparin concentrations sufficient for CPB

Answer 14

3-4 U/mL

Question 15

Thrombocytopenia is defined as?

Answer 15

platelet count of <100,000/uL

Question 16

Hirudin

Answer 16

thrombin inhibitor isolated from leech salivary glands
inhibits clot bound thrombin
inhibits activation of protein C

alternative to UFH

Question 17

Bivalirudin

Answer 17

synthetic
directly inhibits thrombin by binding to its active catalytic site and its substrate recognition site
no reversal agent

alternative to UFH (for HIT pts maybe)

Question 18

Argatroban

Answer 18

direct thrombin inhibitor

alternative to UFH (for HIT pts maybe)

Question 19

After Protamine admin on bypass the ACT should be where?

Answer 19

no more than 10% above value before heparin admin

Question 20

Rapid Protamine admin (3mg/kg in 3 min or less) can cause what?

Answer 20

Hypotension – decreases systemic and pulmonary pressures as well as venous return

Question 21

Hypotension from rapid protamine admin treated how?

Answer 21

rapid fluid admin, large doeses of epiniphrine and possibly bronchodilators (inhaled)

Question 22

Daily aspirin is known as what kind of therapy?

Answer 22

Antiplatelet therapy

to prevent thrombosis, can cause an increase in bleeding post op when taking this up to the day

Question 23

Aprotinin

Answer 23

proteinase inhibitor
inhibits plasmin, kallikrein(reduce inflammatory response) and other serine proteases
decreases activation of hematologic system during CPB and subsequent fibrinolysis resulting in 30-40% decrease in chest tube drainage