Coagulation Disorders Flashcards
steps of blood clotting in normal physiologic process
- vasoconstriction: reduce blood loss when injury occurs
- form platelet plug: platelets adhere to open areas and stick together
- coagulation cascade activates to convert plasma protein fibrinogen into fibrin
- clot retraction/repair: reduce size of clot, approximate edges of wound, fibroblasts proliferate to lay down collagen fibers
- fibrinolysis: clot remove by plasminogen, which is activated into plasmin which dissolves clot
regulation of coagulation
anticoagulants: antithrombin, protein C
tissue factor pathway inhibitor: inhibit extrinsic pathway
fibrinolysis: removal of clots
drug classess for anticoagulation
thrombolytics
anticoagulants
antithrombotics/antiplatelet
indications for anticoagulants
DVT
PE
A fib
MI
arteriosclerosis
acute coronary syndrome
stroke
artificial heart valve
hemodialysis
chronic renal failure
CABG
adverse effects of anticoagulants
increased/excess bleeding
list anticoagulant drugs
warfarin: vitamin K antagonist
heparin
LMWH
dabigatran: direct thrombin inhibitor
Factor Xa inhibitors: fondaparinux
list anti thrombotics
aspirin: COX inhibitor
Plavix: ADP receptor inhibitors
tirofiban, abciximab: glycoprotein inhibitors
list thrombolytics
tPA
reteplase
tenectplase
hemostatic drugs function
promote clot stability
prevent excess bleeding
includes tranexamic acid, aminocaproid acid
vitamin K function
antidote to warfarin overdose/excess anticoagulation
warfarin MOA
vitamin K antagonist
antagonise liver synthesis of vitamin K dependent clotting factors
indications for warfarin
if pt will be on anticoagulation long term
VTE
acute Afib
side effects of warfarin
hemorrhage
fetotoxic
many drug interactions
INR
normal: 1
target in anticoagulation differs: 2.5-3.5
PT considerations on warfarin
bruising
risk of bleeding
fall risk
INR monitoring
heparin MOA
increase antithrombin factor activity to decrease blood clotting protease activity
clinical indications for heparin
DVT
PE
pts going into surgery
acute coronary syndrome/MI!
side effects of heparin
bleeding
thrombocytopenia
osteoporosis
hypersensitivity
PT implications of heparin
bleeding
drug interactions and interactions with deep heat that can increase risk of bleeding
pt education on bleeding
direct thrombin inhibitor MOA
inhibit activity of thrombin in coagulation cascade to reduce blood clotting
indications for direct thrombin inhibitors
prevent stroke
treat/prevent DVT
anticoagulate pts who have thrombocytopenia from heparin use
during PCI procedure
side effects of direct thrombin inhibitors
bleeding
GI effects
factor Xa inhibitors MOA
inhibit Xa in coagulation cascade, prevent conversion to thrombin
indications for factor Xa inhibitors
prevent/treat DVT, PE
prevent stroke or embolism
side effects of factor Xa
bleeding
pain in limbs,
headache,
dizziness,
abdominal pain
antiplatelet drug MOA
prevent platelets from sticking together to form a clot
aspirin targets COX
plavix(clopidogrel)/ticagrelor/pasugrel targetsP2Y12
dipyridamole: inhibit PDE
indications for antiplatelet drugs
angina
a fib
coronary artery disease
PCI after stent placement
stroke
MI
side effects of anti platelet drugs
bleeding
GI bleeding
tinnitus
thrombotic thrombocytopenia purpura
list thrombolytics
tPA
reteplase
tenecteplase
streptokinase
urokinase
thrombolytics MOA
activate conversion of plasminogen into plasmin to degrade fibrin in blood clot
indications of thrombolytics
acute MI
acute stroke
PE
DVT
side effects of thrombolytics
bleeding
allergic rxn
reocculusion
PT consideration on anticoagulants
increased bruising risk
increased risk of post op bleeding
monitor for internal bleeding
dry needling, electroacupuncture, deep tissue mobilization could icnrease hematoma risk, inspect area if using manual technique
monitor for DVT and consider prophylaxis
caution with high intensity exercise
schedule interventions when meds at moderate level of effect
fall prevention
