Coagulation Modifiers

Question 1

Heparin Class

Answer 1

Anticoagulant

Factors IIa and Xa Antagonist

Question 2

Heparin MOA

Answer 2

Heparin forms a complex with antithrombin III, increasing its activity 1,000 times

Inhibits thrombin (IIa) and factor Xa

Depresses factors IXa, XIa, and XIIa

Question 3

Heparin Uses (3)

Answer 3

DVT prophylaxis

Treats

• Pulmonary Embolism
• Acute coronary syndrome

Question 4

Heparin Dosing

Answer 4

SQ:
5,000 units for DVT prophylaxis

IV:
80 units/kg bolus
Followed by 15-18units/kg/hr infusion

Question 5

Heparin Onset and DOA

Answer 5

SubQ
-Onset: 30 min

IV

• Onset: rapid
• DOA: 1-2 hours

Question 6

Heparin Metabolism

Answer 6

Liver

Question 7

Heparin Excretion

Answer 7

Kidneys

Question 8

Heparin Admin Considerations (3)

Answer 8

Check PTT levels
HIT
Bleeding

Question 9

Protamine Class

Answer 9

Heparin Reversal Agent

Question 10

Protamine MOA

Answer 10

Combines with heparin to form inactive compound w/ no anticoagulant effects

Question 11

Protamine Uses

Answer 11

Reversal of heparin

Question 12

Protamine Dosing

Answer 12

Based on amount of heparin given
Give @ <5mg/min
1 mg/ 100 U of heparin

Question 13

Protamine Onset, DOA, and Half-Life

Answer 13

Onset: 5 min

DOA: 2 hours

Half-life: Shorter than heparin, so heparin rebound (bleeding) may occur

Question 14

Protamine Metabolism and Excretion

Answer 14

Heparin-protamine complexes eliminated via reticuloendothelial system

Question 15

Protamine Admin Considerations (6)

Answer 15

Hypersensitivity Response Possible d/t derivation from salmon sperm

• Releases histamine
• Hypotension
• Pulmonary HTN
• Circ collapse
• Facial flushing
• Bronchoconstriction

Question 16

Tranexamic acid (TXA) Class

Answer 16

Antifibrinolytic agent

Question 17

Tranexamic acid (TXA) MOA

Answer 17

Synthetic reversible competitive inhibitor to the Lysine receptor found on plasminogen. The binding of this receptor prevents plasmin (activated form of plasminogen) from binding to and ultimately stabilizingthe fibrin matrix.

Question 18

Tranexamic acid (TXA) Uses

Answer 18

Prevents or reduces bleeding and the need for transfusion

Question 19

Tranexamic acid (TXA) Dosing

Answer 19

1 gram over 10 minutes.

May repeat a 1 gram dose during the next 8 hours, but do not exceed a total of2 grams.

Question 20

Tranexamic acid (TXA) Half-Life

Answer 20

IV

Around 2 hours

Question 21

Tranexamic acid (TXA) Metabolism

Answer 21

Small portion metabolized by the liver

Question 22

Tranexamic acid (TXA) Excretion

Answer 22

Kidneys (large portion unchanged)

Question 23

Tranexamic acid (TXA) Admin Considerations (4)

Answer 23

Rapid infusion may cause hypotension

Contraindications:

• Known allergy to TXA
• Intracranial bleeding (SAH)
• History of venous or arterial thromboembolism or active thromboembolic disease.