Coagulation disorders Flashcards
List three inherited coagulation disorders
Haemophilia A, B and vW disease
What does the clinical picture look like in haemophilia A and B
Increased APTT
Normal PT
Mx for Haem A
AVOID NSAIDS
AVOID IM INJECTIONS
Treat just for bleeds or with prophy factor 8 if severe
Mx for haem B
Treat as prophy or just for bleeds
Three types of vW disease
Type 1 - low
Type 2 - shit
Type 3 - absent
What is low in vW disease
factor 8 as it is normally carried by von willebrand factor
What is the biochemical picture in vW disease
High APTT
Normal PT/INR
Low factor 8
Low vWF antigen
Mx of VW disease
Prophy
Tranexeamic acids
Desmopressin
Combined vWF and factor 8 concetrates
Causes of acquired coagulation disorders
DIC
Liver disease
How do you treat a DVT/PE
LMWH + warfarin (but don’t use warfarin in pregnancy)
OR Apixaban/rivaroxaban
DVT prophylaxis
Prophy dose LMWH + TED stockings
When can you stop LMWH during treatment of a DVT/PE
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
How long does treatment go for for DVT/PE
3 months
Then stop if it was a clearly provoked DVT
Or make a decision about lifelong treatment
How does heparin work
Potentiates anti thrombin 3, which inactivates thrombin and factors 9, 10 and 11
How do you take LMWH
SC daily
Do you need to monitor LMWH
No
When would you need to monitor LMWH
Only in late pregnancy or renal failure
When do you use unfractionated heparin
In renal failure or during VTE at TERM
How long does someone with a DVT/PE during pregnancy need to be on LMWH for
6 week postnatally, at least 3 months in total
If someone has a VTE at term, what do you use?
IV unfractionated heparin
Regional anaesthesia can only be used when
24 hours after stopping any LMWH
When can LMWH be restarted
4 hours after spinal/epidural
SE of heparin
Bleeding
Heparin induced thombocytopenia
Heparin antidote
Protamine sulphate
Warfarin antidote
IV vit K - 6hrs
Prothrombin complex Octaplex/Beriplex) - 30 mins
What do you measure UFH with
APTT
INR range for someone with AF
2-3
INR range for someone with AF and a metallic valve
3-4
How does clopidogrel work
Irreversible antiplatelet
