Coagulation disorders

Question 1

List three inherited coagulation disorders

Answer 1

Haemophilia A, B and vW disease

Question 2

What does the clinical picture look like in haemophilia A and B

Answer 2

Increased APTT
Normal PT

Question 3

Mx for Haem A

Answer 3

AVOID NSAIDS
AVOID IM INJECTIONS
Treat just for bleeds or with prophy factor 8 if severe

Question 4

Mx for haem B

Answer 4

Treat as prophy or just for bleeds

Question 5

Three types of vW disease

Answer 5

Type 1 - low
Type 2 - shit
Type 3 - absent

Question 6

What is low in vW disease

Answer 6

factor 8 as it is normally carried by von willebrand factor

Question 7

What is the biochemical picture in vW disease

Answer 7

High APTT
Normal PT/INR
Low factor 8
Low vWF antigen

Question 8

Mx of VW disease

Answer 8

Prophy
Tranexeamic acids
Desmopressin
Combined vWF and factor 8 concetrates

Question 9

Causes of acquired coagulation disorders

Answer 9

DIC
Liver disease

Question 10

How do you treat a DVT/PE

Answer 10

LMWH + warfarin (but don’t use warfarin in pregnancy)
OR Apixaban/rivaroxaban

Question 11

DVT prophylaxis

Answer 11

Prophy dose LMWH + TED stockings

Question 12

When can you stop LMWH during treatment of a DVT/PE

Answer 12

As soon as INR is in the therapeutic range between 2 and 3

But warfarin induces a procoagulant state by affecting protein C / S in the first few days, hence continue with LMWH initially

Question 13

How long does treatment go for for DVT/PE

Answer 13

3 months
Then stop if it was a clearly provoked DVT
Or make a decision about lifelong treatment

Question 14

How does heparin work

Answer 14

Potentiates anti thrombin 3, which inactivates thrombin and factors 9, 10 and 11

Question 15

How do you take LMWH

Answer 15

SC daily

Question 16

Do you need to monitor LMWH

Answer 16

No

Question 17

When would you need to monitor LMWH

Answer 17

Only in late pregnancy or renal failure

Question 18

When do you use unfractionated heparin

Answer 18

In renal failure or during VTE at TERM

Question 19

How long does someone with a DVT/PE during pregnancy need to be on LMWH for

Answer 19

6 week postnatally, at least 3 months in total

Question 20

If someone has a VTE at term, what do you use?

Answer 20

IV unfractionated heparin

Question 21

Regional anaesthesia can only be used when

Answer 21

24 hours after stopping any LMWH

Question 22

When can LMWH be restarted

Answer 22

4 hours after spinal/epidural

Question 23

SE of heparin

Answer 23

Bleeding
Heparin induced thombocytopenia

Question 24

Heparin antidote

Answer 24

Protamine sulphate

Question 25

Warfarin antidote

Answer 25

IV vit K - 6hrs
Prothrombin complex Octaplex/Beriplex) - 30 mins

Question 26

What do you measure UFH with

Answer 26

APTT

Question 27

INR range for someone with AF

Answer 27

2-3

Question 28

INR range for someone with AF and a metallic valve

Answer 28

3-4

Question 29

How does clopidogrel work

Answer 29

Irreversible antiplatelet