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Hemic-Lymphatic and Clin Path > Coagulation Drugs > Flashcards

Coagulation Drugs Flashcards

1
Q

how often are PTEs clinically silent?

A

about 40% of cats and dogs

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2
Q

when should you use anticoagulants?

A

animals at risk for thrombosis
following thrombotic event

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3
Q

what are the main causes of a hypercoagulable state?

A

neoplasia
immune-mediated disease
protein-losing states
corticosteroid therapy

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4
Q

what is an arterial thrombus like?

A

platelet rich
fibrin rich

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5
Q

what is a venous thrombus like?

A

platelet poor
red blood cell aggregates

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6
Q

what are the three big categories of risk associated with coagulation (Virchow’s triad)?

A

hemodynamic changes/stasis
endothelial injury/dysfunction
hypercoagulability

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7
Q

what causes hemodynamic changes/stasis?

A

turbulent flow
viscosity changes
immobility

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8
Q

what leads to a hypercoagulable state?

A

platelet activation
activation of coagulation factors
reduction in endogenous anticoagulant
reduced fibrinolysis

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9
Q

when should you give prophylactic anticoagulants?

A

IMHA
protein losing nephropathy
cardiomyopathy in cats
pulmonary hypertension
multiple risk factors identified

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10
Q

what are some platelet inhibitors?

A

aspirin
clopidogrel

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11
Q

what are some anticoagulants?

A

coumadin
heparins
factor Xa inhibitors: rivaroxaban

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12
Q

what is the most commonly used platelet inhibitor?

A

aspirin

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13
Q

at what doses does aspirin decrease platelet activation and aggregation?

A

low doses

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14
Q

how does aspirin work?

A

irreversible acetylation of cyclooxygenase

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15
Q

what organ activates clopidogrel?

A

liver: cytochrome p450

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16
Q

how does clopidogrel work?

A

ADP receptor antagonist
irreversible binding to P2Y12 receptor

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17
Q

are there tests for monitoring platelet inhibitors?

A

no clinically available tests

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18
Q

is aspirin or clopidogrel better for giving to cats with ATE?

A

clopidogrel

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19
Q

how does warfarin work?

A

prevents gamma carboxylation of coagulation factors

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20
Q

why is monitoring required for warfarin?

A

unpredictable half-life

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21
Q

what does heparin do?

A

increases inhibitory effect of antithrombin
heparin:antithrombin complex

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22
Q

what does the heparin:antithrombin complex do?

A

inhibits coagulation factors
inhibits thrombin induced platelet activation
prevents factors I and VIII upregulation

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23
Q

how is heparin monitored?

A

aPTT most common

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24
Q

what is the clearance like of heparin?

A

unpredictable

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25
Q

what bioavailability does low molecular weight heparin have after a subcutaneous injection?

A

100%

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26
Q

how is low molecular weight heparin derived?

A

depolymerization of unfractionated heparin

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27
Q

can you use aPTT to monitor low molecular weight heparin?

A

no- minimal change in aPTT

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28
Q

how is low molecular weight heparin monitored?

A

plasma anti-Xa activity

29
Q

what does the anti-Xa assay measure?

A

factor Xa

30
Q

when should you perform a factor Xa assay?

A

renal disease
long term heparin use
high risk of bleeding
high likelihood of thrombotic recurrence
obese/low body weight

31
Q

what is the therapeutic range of anti-Xa?

A

0.5-1.0 U/ml

32
Q

what type of thrombosis is rivaroxaban/xarelto effective against?

A

both venous and arterial

33
Q

how does rivaroxaban work?

A

factor Xa inhibitor

34
Q

what does rivaroxaban reduce?

A

free and clot bound Xa

35
Q

how is rivaroxaban excreted?

A

biliary and renal

36
Q

what do we use rivaroxaban in veterinary medicine for?

A

ATE
PTE
pulmonary hypertension
long term use

37
Q

of warfarin, platelet blockers, unfractionated heparin, and low molecular weight heparin, which ones do you need to monitor anticoagulation?

A

warfarin: yes
platelet blockers: no
unfractionated heparin: yes
low molecular weight heparin: not often

38
Q

what do we use most often to monitor for anticoagulation?

A

serial imaging
clinical signs of clot
bleeding, hematocrit

39
Q

how long should you wait to go to surgery on a dog that is on heparin?

A

12 hours to let heparin wear off

40
Q

what anticoagulants should you put an IMHA dog on?

A

enoxaparin and plavix until 2 weeks after discharge
stop enoxaparin 2 weeks after discharge

41
Q

what drug are protein losing nephropathy animals put on for anticoagulants?

A

plavix

42
Q

what drug do we put pulmonary hypertension animals on?

A

plavix

43
Q

what drugs do we put cats with cardiomyopathy on?

A

enoxaparin and plavix

44
Q

what drugs can we use that are anti fibrinolytic drugs?

A

aminocaproic acid
tranexamic acid

45
Q

when do we use anti-fibrinolytic drugs?

A

perioperatively in greyhounds
severe trauma

46
Q

what happens with the endothelium that leads to a hypercoagulable state?

A

inflammation

47
Q

what does aspirin do at low doses?

A

decrease platelet aggregation and activation

48
Q

what is the dose of aspirin for a cat with ATE?

A

5 mg/cat q72h

49
Q

what is the standard low dose of aspirin?

A

0.5-2 mg/kg q24h

50
Q

what is the dose of clopidogrel?

A

18.75 mg/cat/day
dog: 1 mg/kg/day

51
Q

how can platelet inhibitors be monitored?

A

platelet aggregometry
PFA-100

52
Q

how long does warfarin require to reach therapeutic levels?

A

2-7 days

53
Q

what is the target international normalized ratio for warfarin?

A

2.0-3.0

54
Q

what is the dog dose for warfarin?

A

0.5mg/kg divided BID
48 hour heparin bridging

55
Q

what is the dosing range of unfractionated heparins like?

A

big dosing range: 75-250U TID-QID

56
Q

how are unfractionated heparins administered?

A

3-4 times daily
or CRI

57
Q

why is clearance of unfractionated heparins unpredictable?

A

large molecules bind plasma proteins, macrophages, endothelial cells
smaller molecules cleared more slowly via kidneys

58
Q

what is the target for aPTT with unfractionated heparins?

A

1.5-2.5 baseline measurement

59
Q

why is it important that low molecular weight heparin is 1/3 the weight of unfractionated heparins?

A

factor Xa inhibition occurs with very low molecular weight fragments
high ratio of anti-Xa activity:anti-IIa activity

60
Q

what is the target anti-Xa for low molecular weight heparins?

A

venous: 0.5-1.0 U/ml
coronary: 0.5-1.8 U/ml

61
Q

how does factor Xa inhibition work?

A

reduce free and clot bound Xa
clot bound Xa: enzymatically active

62
Q

which anticoagulant should you monitor with PT?

A

warfarin

63
Q

which anticoagulant should you monitor with aPTT?

A

unfractionated heparin

64
Q

how long should you wait to perform surgery on a patient on plavix?

A

one week

65
Q

how long should you wait to perform surgery on a patient on heparins?

A

12 hours

66
Q

how long should you wait to perform surgery on a patient on rivaroxaban?

A

24 hours

67
Q

how long should you wait to perform surgery on a patient on warfarin?

A

give plasma if must

68
Q

what is the dose of aminocaproic acid?

A

50 mg/kg

69
Q

what do anti fibrinolytic drugs inhibit?

A

plasminogen binding to fibrin
fibrinolysis

Hemic-Lymphatic and Clin Path (33 decks)

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