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Pulmonary Critical Care > Coagulopathy > Flashcards

Coagulopathy Flashcards

1
Q

What is the DVT ppx dose of lovenox for patients with BMI over 40?

A

.5 mg/kg q12h

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2
Q

What is the heparin dose for DVT ppx in patients with GFR <30?

A

5000 units SC q8h

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3
Q

What is your dosing of heparin for ACS? What is the intensity considered to be?
What do you want the aPTT to be?

A

-Low-intensity heparin
-60 U/kg bolus, then 12U/kg/hr
- aPTT 40-60

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4
Q

What is your dosing of heparin for DVT, PE, or ventricular thrombus? What is this intensity considered to be?
What do you want the aPTT to be?

A
  • high-intensity heparin
  • 80 U/kg bolus, then 18U/kg/hr
  • aPTT 70-90
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5
Q

What is your lovenox dose for DVT, PE, ACS and ventricular thrombus?
What can you monitor for this and what do you want the level to be?

A

1 mg/kg SC q12h or 1.5 mg/kg SC qd
Anti-Xa level .6-1.2 U/mL

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6
Q

What do you want to use for anticoagulation in HIT?

A

Argatroban or Fondaparinux

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7
Q

Why do you give Calcium with MTP?

A

Citrate used in stored blood chelates ionized calcium

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8
Q

What labs do you need at the initiation of MTP?

A

CBC, PT/INR, aPTT, fibrinogen, type & crossmatch, ionized calcium, ABG, lactate, serum electrolytes, hepatic and renal function testing, thromboelastograph

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9
Q

What is the R-time in TEG?

A
  • Reaction Time: time it takes for a clot to go from 0 to 2mm thick.
  • driven by intrinsic & extrinsic pathway
  • reflects availability of clotting factors and the ability for form thrombin
  • normal is 5-10 min
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10
Q

What does a lower R-time mean?
What does a high than normal R-time mean?

A
  • R-time lower than normal means hypercoagulability or rapid thrombin generation in setting of bleeding
  • R-time higher than normal means deficiency of clotting factor; inhibition of clotting (heparin, thrombin inhibitors); consumptive coaulopathy
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11
Q

What is the K-time in the TEG?

A
  • Kinetics Time: time it takes for the clot to go from 2 to 20 mm thick.
  • due to the conversion of fibrinogen to fibrin, fibrin deposition, and cross-linking. Also somewhat dependent on platelet function
  • normal K-time is 1-3 minutes
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12
Q

What is the alpha-angle in TEG?

A
  • angle between the end of the R-time and the rate of maximal clot formation. Corresponds closely with K-time
  • driven primarily by fibrinogen
  • normal alpha-angle is 53-73 degrees
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13
Q

What does it mean if K-time is lower than normal and alpha angle is higher than normal

A

hypercoagulability; rapid clot formation in the setting of hemorrhage

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14
Q

What does it mean if the K-time is higher than normal and alpha angle is lower than normal

A

fibrinogen depletion; consumptive coagulopathy; dysfibrinogenemia; significant platelet deficiency of dysfunction

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15
Q

What is the MA in TEG?

A
  • Maximal Amplitude: maximum thickness of the clot
  • largely dependent on platelet function
  • normal MA is 50-70mm
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16
Q

What does it mean when the MA (maximal amplitude) is lower than normal?

A

thrombocytopenia; thrombasthenia; platelet inhibition with medications; uremic platelet dysfunction

17
Q

What does it mean when the MA (maximal amplitude) is higher than normal?

A

hypercoagulability

18
Q

What is the LY-30 in the TEG?
What does a high LY-30 mean?

A

LY-30: percentage of clot that is lysed 30 minutes after reaching maximal amplitude
- normal is 0-8%
- high LY-30 means accelerated fibrinolysis; presence of activated plasminogen

19
Q

When is TEG useful?
What are limitations of TEG?

A
  • useful: MTP; patients who have coagulation derangements but may not actually have a high bleeding risk (cirrhotics)
  • limitations: does not indicate specific coagulation factor deficiences or distinguish bt intrinsic and extrinsic pathway problems. Cannot be used to screen for DVT or PE.
    **R-time may be normal in setting of warfarin, even with therapeutic INR.
20
Q

What is in cryoprecipitate?
What is it used for? Dose?

A
  • fibrinogen, Factor VIII, vWF. more concentrated source of fibrinogen than FFP
  • could use 2 units in dabigatran reversal if fibrinogen <200
  • really only used when factor concentrates or concentrated fibrinogen are unavailable
21
Q

What is in Prothrombin Concentrate (PCC/Kcentra)?
What is it used for?
Dose?

A
  • Factor II (prothrombin), factor VII, Factor IX, and Factor X
  • warfarin reversal - depends on INR (25-50 U/Kg)
  • in liver dz
  • eliquis & xarelto reversal, actually recommended over andexenant still - 25-50 U/kg
22
Q

What is the dosage of Kcentra reversal for warfarin?

A

INR 2-4: 25 U/kg
INR 4-6: 35 U/kg
INR >6: 50U/kg
or
fixed dose 1500 U

23
Q

What is the reversal agent for apixaban and rivaroxaban? Dose?

A

andexanet - 400 mg bolus followed by 480 mg over 2 hours
- but really Kcentra is preferred reversal agent (25-50 U/kg)

Pulmonary Critical Care (5 decks)

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