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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

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
Factor Complex concentrates
from pooled human plasma | biological product of pooled human plasma with therapeutic concentrations of factors 2, 7, 9, 10
26
4 factor:
kcentra | FEIBA
27
3 factor:
profilnine (low amounts of FVII)
28
Clinical uses of factor complex concentrates
reverses the effects of significant vitamin K antagonism coagulopathy emergent or urgent surgery clotting deficiency Contraindicated in DIC and HIT
29
Kcentra can help reverse
factor Xa inhibitors like xarelto and eliquis however at higher dosing
30
KCentra is not used for
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
Recombinant activated factor 7
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
Novoseven off label use is
treatment of coagulopathy and major blood loss (postpartum hemorrhage, trauma, reversal of various anticoagulants, and high risk cardiothoracic, spinal, transplant, or vascular surgery
33
What is increased with rFVIIa?
thrombosis in some settings, particulary in patients who do not have hemophilia
34
What is rfVIIa an activated form of?
factor VII, which bypasses VIII and IX and causes coagulation without the need for factors VIII and IX
35
How does does rfVIIa promote hemostasis?
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
What does rfVIIa theoretically do?
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
What are the two pathways of Factor VIIa
site of tissue injury combine with tissue factor to directly activate factor X platelet surface
38
Factor VIIa Dosing
20ug/kg over 200ug/kg 90mcg/kg bolus IV reconstitute with SW re-dose can occur every 2 hours
39
Additional considerations of Factor VIIa
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
Half life of Factor VII is
2-2.5 hours

N929 Pharmacology (16 decks)

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