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N929 Pharmacology > Emergent Reversal of Anticoagulants > Flashcards

Emergent Reversal of Anticoagulants Flashcards

1
Q

Reversal Agents

A

antiplatelet agents (platelet transfusions)
heparins (protamine)
vitamin K antagonist (warfarin)
- 3 and 4 factor PCC
-vitamin K
direct thrombin inhibitors
-idarucizumab (reversal of dabigatran)
-andexanet alfa (reverses apixaban or rivaroxaban)
emerging agent
- ciraparangtag (reversals UFH, LMWH, fondaparinux, dabigatran, FXa)

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2
Q

FFP

A

variable but near normal levels of coagulation factors, coagulation inhibitors, albumin, and immunoglobins

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3
Q

Cryoprecipiate

A

slowly thawing FFP leaves behind a cold-insoluble precipitate which contains fibrinogen, FVIII, vWF and FXIII

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4
Q

Factor concentrates

A

plasma derived and recombinant (jehovah’s witness)

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5
Q

Coagulation Factors in FFP

A

2, VII, VIIII, IX,X, XI

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6
Q

Coagulation Factors in PCC

A

concentrated coagulation factors

II, VII, IX, X, XII, protein C and Protein S

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7
Q

Cryoprecipitate

A

fibrinogen

von willebrand factor

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8
Q

Fresh Frozen Plasma

A

thawed FFP contains variable but near normal levels of procoagulant proteins, coagulation inhibitors, albumin, and immunoglobulins

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9
Q

Efficacy of FFP transfusions are assessed by

A

PT/INR, PTT, fibrinogen level adn platelet count, viscoelastic tests which take about 30-90 minutes

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10
Q

Slowly thawing FFP leaves behind a

A

cold-insoluble precipitate which contains fibrinogen, FVIII, vWF and FXIII

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11
Q

FFP: Fibrinogen content per vial or unit

Volume per vial or unit

A

0.5g/250ml per unit

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12
Q

Cryoprecipitate:
Fibrinogen content per vial or unit
Volume per vial or unit

A

0.3g/20ml per unit

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13
Q

Plasma-derived fibrinogen:
Fibrinogen content per vial or unit
Volume per vial or unit

A

0.9-1.3g/50ml per vial

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14
Q

Blood Product Compatibility and administration

A

Filter + warmer

PRBCS, FFP, Cryopreciptate

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15
Q

Platelet Administration

A

Platelets

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16
Q

Factor Concentrates

A

Plasma derived and recombinant

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17
Q

Plasma derived

A 
Factor VIII, Factor IX, factor XIII
riastap
FEIBA
profinine
kcentra
18
Q

riastap

A

fibrinogen concentrate factor I

19
Q

FEIBA

A

factor eight inhibitor bypassing activity-mainly contains no activated II, IX, X and mainly activated VII along with heparin, AT and PROC &S

20
Q

Profinine

A

factors 2,7 and 10
3 factor complex concentrate which was originally approved for treatment of patients with hemophilia B (factor IX deficiency)
not for warfarin or factor X reversal

21
Q

kcentra

A

factors 2, 7, 9 and X
4 factor complex concentrate which is approved for reversal of vitamin K antagonist
contains anti-thrombotic proteins C and S and heparin 8-40 units in 500 unit vials in addition to factors 2, 7, 9 and 10
approved for treatment of adult patients with vitamin K antagonist with an INR >1.5 adn experiencing acute major bleeding

22
Q

Recombinant

A

factor VIIa, Factor IX

23
Q

Patient bleeding from warfarin will administer

A

kcentra

24
Q

Riastap Human derived fibrinogen concentrate

A

fibrinogen concentrate is fractionated from blood and is stored at room temperature for up to 30 month
can be quickly reconstituted and administered IV with no thawing or blood type machine required
Fibrinogen concentrate is standardized in each vial

25
Q

Factor Complex concentrates

A

from pooled human plasma

biological product of pooled human plasma with therapeutic concentrations of factors 2, 7, 9, 10

26
Q

4 factor:

A

kcentra

FEIBA

27
Q

3 factor:

A

profilnine (low amounts of FVII)

28
Q

Clinical uses of factor complex concentrates

A

reverses the effects of significant vitamin K antagonism coagulopathy
emergent or urgent surgery
clotting deficiency
Contraindicated in DIC and HIT

29
Q

Kcentra can help reverse

A

factor Xa inhibitors like xarelto and eliquis however at higher dosing

30
Q

KCentra is not used for

A

patients with INR less then 1.5 on VKAs
elective reversal of anticoagulant therapy
treatment of elevated INRs without bleeding or need for surgical intervention
massive transfusion coagulopathy
coagulopathy associated with hepatic dysfunction
patients with DIC and bleeding diathesis
patiens with history of HIT

31
Q

Recombinant activated factor 7

A

novoseven
rFV7 is form of blood factor 7
glycoprotein produced by recombinant DNA technology
used in hemophilia A or B, congenital factor 7 deficiency

32
Q

Novoseven off label use is

A

treatment of coagulopathy and major blood loss (postpartum hemorrhage, trauma, reversal of various anticoagulants, and high risk cardiothoracic, spinal, transplant, or vascular surgery

33
Q

What is increased with rFVIIa?

A

thrombosis in some settings, particulary in patients who do not have hemophilia

34
Q

What is rfVIIa an activated form of?

A

factor VII, which bypasses VIII and IX and causes coagulation without the need for factors VIII and IX

35
Q

How does does rfVIIa promote hemostasis?

A

activates the extrinsic pathway of the coagulation cascade by forming a complex tissue factor at teh site of injury activating coagulation factors IX and X which leads to the formation of the hemostatic plug

36
Q

What does rfVIIa theoretically do?

A

mechanism that localized the action of factor VIIa to teh site of injury and hence avoid the complications of thrombosis occuring in other vascular beds
used in head bleeds

37
Q

What are the two pathways of Factor VIIa

A

site of tissue injury combine with tissue factor to directly activate factor X
platelet surface

38
Q

Factor VIIa Dosing

A

20ug/kg over 200ug/kg
90mcg/kg bolus IV
reconstitute with SW
re-dose can occur every 2 hours

39
Q

Additional considerations of Factor VIIa

A

risk of thrombotic adverse events
factor VIii will not stop surgical hemorrhage, its a temporizing agent
adequate FFP, cryo and platelets need to be present for full effect

40
Q

Half life of Factor VII is

A

2-2.5 hours

N929 Pharmacology (16 decks)

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