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Clin Med Final Material- Semester 2 > Coagulation: schoenwald > Flashcards

Coagulation: schoenwald Flashcards

1
Q

Acquired Conditions and Risk Factors

A
  • Venous stasis–> Long periods of immobilization-travel, illness
  • Antiphospholipid syndrome-autoimmune
  • Atrial fibrillation

-Cancer–> Mass affect pressing on vein
or Tumor produces substances promoting clotting

  • Treatments (chemo/radiation)
  • Trauma/surgery
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2
Q

Acquired Conditions and Risk Factors (cont.)

A 
Central line catheters
Pregnancy
Medications
Hormone replacement therapy
Oral contraceptives
Tamoxifen
Heparin in heparin induced thrombocytopenia
Atherosclerosis
Obesity
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3
Q

Antiphospholipid syndrome= ______ antibodies

A

Autoimmune-cardiolipin antibodies

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4
Q

Antiphospholipid syndrome:

-clinical criteria=

A

-Vascular thrombosis-validated by imaging or biopsy

-**Pregnancy complications:
1 or more unexplained deaths of physically normal fetus at or after 10 weeks or pregnancy
1 or more premature births of physically normal newborn at or before 34 weeks due to pre-eclampsia, eclampsia or abnormally functioning placenta
3 or more unexplained consecutive miscarriages before the 10th week

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5
Q

Antiphospholipid syndrome:

-lab criteria

A

-Positive test for 1 autoantibody on 2 or more occasions 12 weeks apart

  • -Lupus anticoagulant
  • -Anticardiolipin antibody
  • -Anti B2GP1 antibody
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6
Q

Antiphospholipid Syndrome: Treatment

A
  • Lifelong anticoagulation
  • *Warfarin contraindicated in pregnancy (category X)
  • **Transition to LMWH during pregnancy
  • NOACS?
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7
Q

Inherited Clotting conditions:

Factor V Leiden mutation (activated protein C resistance)

A
  • Mutation causes single amino acid replacement at 1 of 3 cleavage sites of Factor V
  • Protein C cannot inactivate the cleavage Factor V in presence of Factor V Leiden mutation-slows the clotting cascade because of persistent Factor V Leiden activity=increase in thrombin generation
  • **Most common hereditary blood coagulation disorder in US-5% of Caucasians, 1.2% African Americans
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8
Q

Inherited Clotting conditions:

-Prothrombin ______ mutation

A
  • *Prothrombin 20210 mutation

- -Results in increased prothrombin (Factor II)

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9
Q

Inherited Clotting conditions (List others)

A
  • MTHFR mutation: Predisposes to high levels of homocysteine and MAY increase clotting risk
  • Protein C: Helps regulate speed of coagulation cascade by degrading factors V and VIII
  • Protein S: Cofactor with Protein C
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10
Q

Inherited clotting disorders:

dx by?

A

running factor assays or specific genetic tests

  • Can be heterozygous (inherited one mutated gene copy and one normal copy) or homozygous (inherited 2 mutated gene copies)
  • *Homozygous usually more severe

-Hypercoagulation panel:
Factor V Leiden
Prothrombin gene 20210 mutation
Protein C and Protein S activity
MTHFR gene-Methylenetetrahyrofolate Reductase
Homocysteine
Anticardiolipin antibodies-antiphospholipid syndrome

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11
Q

Hyper coag panels include?

A

Factor V Leiden
Prothrombin gene 20210 mutation
Protein C and Protein S activity
MTHFR gene-Methylenetetrahyrofolate Reductase
Homocysteine
Anticardiolipin antibodies-antiphospholipid syndrome

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12
Q

inherited clotting disorders: tx?

A

lifelong anticoag

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13
Q

Anticoagulation Agents:

describe warfarin

A

MOA: inhibits vitamin K dependent factors
Usage:prophylaxis and treatment of DVT and PE, afib
Only anticoagulant that prevents activation of new clotting factors
Slow onset of action: 3-5 days to become therapeutic
Stabilizes clot
Oral delivery
Multiple drug interactions

  • **Therapeutic Drug Monitoring is INR
  • **Reversal Agent: Vitamin K or FFP
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14
Q

Anticoagulation Agents:

-describe unfractionated heparin

A

MOA: binds to antithrombin, inhibits Factors II, IXa,Xa,Xia,XIIa
Used for prophylaxis and treatment of DVT/PE/Afib
IV

  • *Monitoring PTT and CBC(HIT monitoring)
  • Reversal agent-protamine sulfate
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15
Q

Anticoag agents:

-describe Low molecular Weight Heparin (LMWH)

A

=aka Dalteparin (Fragmin) or Enoxaparin (Lovenox)

  • MOA :binds to antithrombin to inhibit factors Xa and Iia (mostly Xa-Xa activity of LMWH much higher than unfractionated heparin
  • Used in prophylaxis and treatment of DVT/PE, unstable angina, nonQ wave MI
  • Stabilizes clot
  • Used with warfarin as bridge until INR therapeutic
  • **May be used in pregnancy

Reversal agent is protamine sulfate

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16
Q

What is the blackbox warning regarding LMWH??***

A

Spinal procedures such as epidural catheter placement,lumbar puncture can result in epidural or spinal hematoma=paralysis

17
Q

Describe NOACS-Novel oral anticoagulants

-which ones are direct thrombin inhibitors?

A
  • Bivalirudin (Angiomax)- direct thrombin inhibitor

- Dabigatran (Pradaxa)- direct thrombin inhibitor

18
Q

Describe NOACS-Novel oral anticoagulants

-which ones are Factor Xa inhibitors?

A

Apixaban (Eliquis)-Factor Xa inhibitor
Rivaroxaban (Xarelto)-Factor Xa inhibitor
Edoxaban (Savaysa)-Factor Xa inhibitor

19
Q

What are all Pts at risk for that take NOACs?

A

Spinal hematoma a risk for all of these agents if used during spinal/epidural procedures

20
Q

Direct Thrombin Inhibitors

-MOA?

A

MOA: prevent cleavage of fibrinogen to fibrin monomers and thrombin induced platelet aggregation
Stabilize active clots and prevent formation of new clots
-Bivalirudin (used mainly as IV med in acute coronary syndromes)
-and Dabigatran

21
Q

When is Dabigatran used?

A

(a direct thrombin inhibitor)
-Used in afib, prophylaxis and treatment of DVT/PE
Oral alternative to warfarin therapy
No laboratory monitoring

Reversal agent: idarucizumab (Praxbind)-monoclonal antibody

22
Q

Factor XA inhibitor

-MOA?

A

MOA: inhibit Factor Xa
Used for a fib, prophylaxis and treatment of DVT/PE including post op prophylaxis
Apixaban (Eliquis), Rivaroxaban (Xarelto), edpxaban (Savaysa)-oral
No lab monitoring
Stabilize clot and prevent new formation of clots, slowly dissolve pathologic clots

23
Q

Factor XA inhibitor

Reversal agent: for apixaban and rivaroxaban only?

A

Factor Xa(recombinant) inactivated-Andexxa- acts as decoy for binding cost=$50,000/dose

24
Q

Von willibrand disease

-describe

A

=Deficiency of vonWillibrand factor

-VWF is a carrier for Factor VIII and platelets

-Deficiency causes: prolonged bleeding, Frequent nosebleeds, Easy bruising
Excessive bleeding with procedures

-DDAVP (synthetic vasopressin) stimulates cellular release of VWF

25
Q

Von willibrand disease:

-what labs should you order?

A

prolonged bleeding time, normal PT,

*PTT MAY be slightly elevated.

26
Q

DIC=

A

Inappropriate clotting mechanism-futile clotting and bleeding

27
Q

DIC results from

A

Result of organ injury, sepsis, amniotic fluid embolism, retention of dead fetus, malignancy, liver cirrhosis, surgery, trauma, burns
–Organ injury results due to intravascular clots and subsequent ischemia/anoxia

28
Q

DIC: tx?

A

Heparin as treatment to limit futile clotting

29
Q

Labs of DIC:

  • Which ones are prolonged?
  • which ones are decreased?
A

-prolonged: bleeding time, PT, PTT, thrombin time

**Platelets are decreased

Clin Med Final Material- Semester 2 (22 decks)

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