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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
what bioavailability does low molecular weight heparin have after a subcutaneous injection?
100%
26
how is low molecular weight heparin derived?
depolymerization of unfractionated heparin
27
can you use aPTT to monitor low molecular weight heparin?
no- minimal change in aPTT
28
how is low molecular weight heparin monitored?
plasma anti-Xa activity
29
what does the anti-Xa assay measure?
factor Xa
30
when should you perform a factor Xa assay?
renal disease long term heparin use high risk of bleeding high likelihood of thrombotic recurrence obese/low body weight
31
what is the therapeutic range of anti-Xa?
0.5-1.0 U/ml
32
what type of thrombosis is rivaroxaban/xarelto effective against?
both venous and arterial
33
how does rivaroxaban work?
factor Xa inhibitor
34
what does rivaroxaban reduce?
free and clot bound Xa
35
how is rivaroxaban excreted?
biliary and renal
36
what do we use rivaroxaban in veterinary medicine for?
ATE PTE pulmonary hypertension long term use
37
of warfarin, platelet blockers, unfractionated heparin, and low molecular weight heparin, which ones do you need to monitor anticoagulation?
warfarin: yes platelet blockers: no unfractionated heparin: yes low molecular weight heparin: not often
38
what do we use most often to monitor for anticoagulation?
serial imaging clinical signs of clot bleeding, hematocrit
39
how long should you wait to go to surgery on a dog that is on heparin?
12 hours to let heparin wear off
40
what anticoagulants should you put an IMHA dog on?
enoxaparin and plavix until 2 weeks after discharge stop enoxaparin 2 weeks after discharge
41
what drug are protein losing nephropathy animals put on for anticoagulants?
plavix
42
what drug do we put pulmonary hypertension animals on?
plavix
43
what drugs do we put cats with cardiomyopathy on?
enoxaparin and plavix
44
what drugs can we use that are anti fibrinolytic drugs?
aminocaproic acid tranexamic acid
45
when do we use anti-fibrinolytic drugs?
perioperatively in greyhounds severe trauma
46
what happens with the endothelium that leads to a hypercoagulable state?
inflammation
47
what does aspirin do at low doses?
decrease platelet aggregation and activation
48
what is the dose of aspirin for a cat with ATE?
5 mg/cat q72h
49
what is the standard low dose of aspirin?
0.5-2 mg/kg q24h
50
what is the dose of clopidogrel?
18.75 mg/cat/day dog: 1 mg/kg/day
51
how can platelet inhibitors be monitored?
platelet aggregometry PFA-100
52
how long does warfarin require to reach therapeutic levels?
2-7 days
53
what is the target international normalized ratio for warfarin?
2.0-3.0
54
what is the dog dose for warfarin?
0.5mg/kg divided BID 48 hour heparin bridging
55
what is the dosing range of unfractionated heparins like?
big dosing range: 75-250U TID-QID
56
how are unfractionated heparins administered?
3-4 times daily or CRI
57
why is clearance of unfractionated heparins unpredictable?
large molecules bind plasma proteins, macrophages, endothelial cells smaller molecules cleared more slowly via kidneys
58
what is the target for aPTT with unfractionated heparins?
1.5-2.5 baseline measurement
59
why is it important that low molecular weight heparin is 1/3 the weight of unfractionated heparins?
factor Xa inhibition occurs with very low molecular weight fragments high ratio of anti-Xa activity:anti-IIa activity
60
what is the target anti-Xa for low molecular weight heparins?
venous: 0.5-1.0 U/ml coronary: 0.5-1.8 U/ml
61
how does factor Xa inhibition work?
reduce free and clot bound Xa clot bound Xa: enzymatically active
62
which anticoagulant should you monitor with PT?
warfarin
63
which anticoagulant should you monitor with aPTT?
unfractionated heparin
64
how long should you wait to perform surgery on a patient on plavix?
one week
65
how long should you wait to perform surgery on a patient on heparins?
12 hours
66
how long should you wait to perform surgery on a patient on rivaroxaban?
24 hours
67
how long should you wait to perform surgery on a patient on warfarin?
give plasma if must
68
what is the dose of aminocaproic acid?
50 mg/kg
69
what do anti fibrinolytic drugs inhibit?
plasminogen binding to fibrin fibrinolysis

Hemic-Lymphatic and Clin Path (33 decks)

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