Coagulation disorders Flashcards
Warfarin Major bleed T
Stop W
Cit K IV 5mg (phytomenodione K1)
Prothrombin Complex Bereplex 50u/kg
(cant: FFP)
Warfarin Minor bleed T
Stop W
Vit K IV 1-3mg (phytomenodion K1)
Repeat in 24hr if INR still high
Restart warfarin INR
INR 5-8 (no bleed)
Omit 1-2 doses
Adjust after
INR 8+ (no bleed)
Stop W
Vit K oral 1-5mg (swallow IV prep phytomenodione K1)
Repeat in 24hr if INR still high
Warfarin mechanism
Vit K dependent factors
2,7,9,10
Protein C + S
Warfarin half life
> 40hr
INR aim post 1st VTE
provoked: 2-3 for 3m
unprovoked: 2-3 for 6m
INR aim post recurrent VTEs no treatment
2-3 for life
INR aim recurrent VTEs ON treatment
3-4 for life
INR aim on HEART VALVES
Mechanical Aortic 2-3
Mechanical mitral 2.5-3.5
Describe Intrinsic pathway
Eposed collagen 12a hageman 11a 9a + 8a 10a + 5a 2a thrombin 1a + 13a fibrin clot
Describe extrinsic pathway
tissue damage 7a + tissue factor thromboplastin 3 10a + 5a 2a thombin 1a + 13a Fibrin clot
Vit K factors
7, 9, 10, 2
protein C + S
Thrombomodulin
+ 2a thrombin + Protein S
causes Protein C -> Active protein C
INHIBITs 5a + 8a
Antithrombin 3
Binds heparin
HMWH/ unfractionated: 2,9,10,11,12 (IV)
LMWH: 10a only (SC)
Tissue Factor Pathway inhibitor
Inhibts 7aTF
Fibrinolysis (tPa)
tPa
Plaminogen to Plasmin
Fibrin to Fibrinogen
Measuring intrinsic
aPPT
Measuring extrinsic
PT
Thrombin functions
Activates 11, 8, 5 and 13
+thrombomodulin & protein S -> activate Protein C
Haemophilia A
Low Factor 8
A8
Haemophilia B
Low Factor 9
B9
Haemophilia inheritence
X linked (male only) female carry
Haemarthrosis
haemophilia
Christmas disease
Haemophilia B9
Haemophilia bloods
High APPT (intrinsic) normal PT (extrinsic) normal vWF Low 8 (A) or 9(B)
haemophilia A T
Replace A8
Demopression increases 8
haemophilia B T
Replace B9
Variant CJD risk
Haemophilia
Chronic arthropathies
Haemophilia
High APPT (intrinsic) normal PT (extrinsic) normal vWF Low 8 (A) or 9(B)
Haemophilia
High APPT,
normal PT
low vWF
Low 8
vW disease
No 1 bleeding disorder
vW disease
vW disease types
1-partial drop in vWF
2-abnormal vWF
3-NovWF
vW disease inheritence
Autosomal dominant (type 3-no vWF is AR)
vW disease T
Desmopression inreases vWF + 8
vW rich factor 8/ vWF concentrate
TRANEXAMIC ACID
Thrombophilia primary causes
LOW Protein C Protein S Antithrombin 3 Factor 5 Leiden (active protein C cant break 5a down)
commonest heritable thrombophilia
Factor 5 Leiden (active protein C cant break 5a down)
Virchows triad
Venous stasis
Hypercoagulation
Vascular injury
Homan’s sign
Pain dorsiflexion in calf DVT
risk of dislodgeing
VTE treatment
- LMWH/ Fondaparinux for 5d+ AND INR >2.0 for 24hr
2, within 24hr start WARFARIN
-Provoked 3month
-Unprovoked 6months
CANCER
- LMWH 6months + compression stocking 2yrs
Unprovoked = screen for cancer
-exam, CXR, FBC, Ca2+, LFTs, urinalysis
+/- >40yr CTCAP/ mammography
Unprovoked = screen for thrombophilia + antiphospholipid if their on gna be on lifelong warfarin
USS review in 1 week
Thrombophilia secondary cuases
Immobility, surgery, malignany, smoking, pregnancy
ANTI-PHOSPHOLIPID SYNDROME
Oestrogens (COCP)
Prophylaxis on flights
Aisle seat
Ankle exercises
Stockings
VTE investigations
Two level Wells score
2+ = USS
