Deck 2 Flashcards
Dx for bleeding disorder with an elevated PT that completely corrects with PT mix
Factor VII deficiency—tx with rFVIIa prior to invasive procedures
Why is a negative family history common in ppl with factor VII deficiency?
It is autosomal recessive
Elevated PT/PTT with complete correction and normal thrombin time suggests what?
Common pathways deficiency but NOT fibrinogen. The remaining factors are II, V, and X
What is the treatment for factor II deficiency?
Prothrombin deficiency; tx = PCC
How long to hold DOAC, assuming normal renal function, prior to minor surgery? Major?
2 days prior to minor; 3 days prior to major
Assuming normal renal function, how many days after minor surgery until restarting DOAC? Major surgery?
1 day after for minor, 2 days after for major
Assuming normal renal function, for how many days before and after minor surgery should a DOAC be held? Major?
2 days before minor, restart 1 day after; for major stop 3 days prior and restart 2 days after
Dosing of apixaban and rivaroxaban for extended AC after 6 months of full dose AC
Apixaban 2.5 mg bid
Rivaroxaban 10 mg daily
What is the main difference in MOA of LMWH and fondaparinux?
LMWH inhibits Xa AND IIa (thrombin) by potentiating antithrombin but fondaparinux only inhibits Xa also longer half life (4 vs 18 hr)
How does LMWH inhibit IIa?
By potentiating antithrombin (antithrombin III— nb IIa is thrombin) main effect is on Xa though
For patients on LMWH what is the ideal timing to check anti-Xa level? Therapeutic range?
3-4 hours after injection; 0.6-1.2 U/mL
What is the therapeutic range for twice daily LMWH vs once daily on anti-Xa? When should you check level?
0.6-1.2 for twice daily; 1-2 for once daily; either way should check 3-4 hours after injection
In a patient who cannot be on other anticoagulants other than LMWH who develops recurrent thrombosis on LMWH what is the mgmt?
Increase dose 25-33%
How many points on 4T are considered low risk?
<3 points (<5% probability)
How many points on 4T is intermediate risk for HIT
4-5 points (~14% probability)
How many points on 4T is high risk of HIT?
6-8 (~64% probability)
On the 4T score there are a max of 8 points and 3 general categories- low risk, intermediate risk, and high risk. What are the general probabilities associated with each?
Low risk <5%
Intermediate 14%
High risk 64%
What are the 2 available functional HIT assays?
Serotonin Release Assay (SRA) and heparin-induced platelet activation (HIPA)
What are the 2 parenteral DTIs for HIT?
Argatroban safe in renal impairment
Bivalrudin safe in hepatic impairment (sounds like bilirubin)
What are the clinical criteria for pregnancy comorbidity in APS?
One or more fetal deaths > 10th week gestation
One or more deaths before 34th week due to eclampsia, preeclampsia, or placental insufficiency
Three or more deaths <10th week
If there is concern for PT/INR confounding due lupus anticoagulant what else can be used to monitor warfarin efficacy? Therapeutic range?
Chromogenic Factor X; 20-40%
When might you use a chromogenic factor X assay for warfarin? Therapeutic range?
If concern about nonreliable PT/INR ie due to lupus inhibitor; 20-40%
MC MPN associated with Budd Chiari
Polycythemia Vera
In PNH there is an acquired mutation in which gene?
PIGA (phosphotidylinositol-glycan class A)