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cardio module > Exam 2 - thrombo disorders > Flashcards

Exam 2 - thrombo disorders Flashcards

1
Q

sequence for primary hemostasis

A

platelet adhesion, activation, aggregation

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2
Q

secondary hemostasis

A

coagulation cascade that leads to a fibrin clot

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3
Q

intrinsic pathway

A

involves Factors XI, IX–>VIII/X

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4
Q

extrinsic pathway

A

involves TF, Factor VII –>X

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5
Q

common pathway

A

starts with Factor X–>fibrin clot

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6
Q

4 inhibitors of the coagulation cascade

A

AT (antithrombin III), PC (protein C), PS (protein S), PAI (Plasminogen activator inhibitor)

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7
Q

venous thrombosis

A

“red clots”- composition is almost entirely fibrin and erythrocytes with small platelet head; can form in any part of venous system, usually in response to either venous stasis or vascular injury

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8
Q

3 components of Virchow’s triad

A

Vascular injury, stasis, hypercoagulability

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9
Q

Examples of Venous thrombosis

A

DVT, PE

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10
Q

Arterial thrombosis

A

“white clots” - platelets + fibrin in areas of rapid blood flow in response to an injured or abnormal vessel wall

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11
Q

examples of arterial thrombosis

A

MI, CVA, TIA

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12
Q

Trauma

A

Transient

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13
Q

Major orthopedic surgery

A

Transient

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14
Q

Major medical illness

A

Acquired

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15
Q

Major surgery

A

Transient

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16
Q

Paralysis/immobility

A

Acquired

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17
Q

Obesity

A

Acquired

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18
Q

Varicose veins

A

Acquired

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19
Q

Malignancy

A

Acquired

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20
Q

IBD

A

Acquired

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21
Q

Hormone therapy

A

Transient

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22
Q

Pregnancy

A

Transient

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23
Q

APA syndrome

A

Acquired

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24
Q

Factor V Leiden

A

Inherited

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25
Q

Protein C deficiency

A

Inherited

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26
Q

Protein S deficiency

A

Inherited

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27
Q

Antithrombin III deficiency

A

Inherited

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28
Q

DVT defintion

A

thrombus that forms in venous

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29
Q

PE definition

A

an embolism that usually arises from a thrombus in the venous system that dislodges and then lodges in the pulmonary vasculature causing complete or partial obstruction of blood flow

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30
Q

diagnostic criteria for VTE

A

Clinical manifestations, risk factor assessment, objective tests, hyper coagulable work-up

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31
Q

indications for Hypercoagulable work-up

A

<40 y/o and idiopathic

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32
Q

manifestations of DVT: location

A

can occur in any vein (usually lower extremities; distal or proximal (knee)

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33
Q

manifestations of DVT: Sx

A

edema, tenderness, pain, erythema, warmth, often unilateral

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34
Q

manifestations of DVT: physical exam

A

palpable cord, homan’s sign: + if pain behind the knee or calf upon dorsiflexion of the foot

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35
Q

manifestations of DVT: complications

A

Acute: PE, limb viability
Chronic: recurrent VTE, post-thrombotic syndrome

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36
Q

manifestations of PE: common sx

A

chest pain, dyspnea, tachypnea, tachycardia, hemoptysis

37
Q

manifestations of PE: other sx (not common)

A

palpitations, cough, diaphoresis, low-grade fever, hypotension

38
Q

manifestations of PE: ominous signs

A

CV collapse (characterized by cyanosis, shock, and oliguria)

39
Q

manifestations of PE: complications

A

Acute: death, right ventricular dysfunction
Chronic: recurrent VTE, pulmonary HTN, cor pulmonale

40
Q

5 etiologies of Cardioembolic stroke

A

A.Fib, Heart valve replacement, Recent MI, Left ventricular mural thrombus, Left ventricular dysfunction

41
Q

thrombogenicity of types/positions of heart valve replacements

A
  1. muliple valves > mitral valve > Aortic valve

2. Caged ball > Single-tilting disk > Bileaflet-tilting disk > Bioprosthetic

42
Q

measures alterations in the intrinsic pathway of clotting cascade; used to monitor heparin therapy

A

aPTT

43
Q

measures EXTRINSIC pathway of clotting cascade and is used to monitor warfarin therapy

A

PT

44
Q

measures anti-Xa activity and may be used to monitor LMWH and fondaparinux

A

Anti-Xa

45
Q

measures activity of factors 7-11

A

ACT

46
Q

manifestations of DVT: complications

A

Acute: PE, limb viability
Chronic: recurrent VTE, post-thrombotic syndrome

47
Q

manifestations of PE: common sx

A

chest pain, dyspnea, tachypnea, tachycardia, hemoptysis

48
Q

manifestations of PE: other sx (not common)

A

palpitations, cough, diaphoresis, low-grade fever, hypotension

49
Q

manifestations of PE: ominous signs

A

CV collapse (characterized by cyanosis, shock, and oliguria)

50
Q

manifestations of PE: complications

A

Acute: death, right ventricular dysfunction
Chronic: recurrent VTE, pulmonary HTN, cor pulmonale

51
Q

5 etiologies of Cardioembolic stroke

A

A.Fib, Heart valve replacement, Recent MI, Left ventricular mural thrombus, Left ventricular dysfunction

52
Q

thrombogenicity of types/positions of heart valve replacements

A
  1. muliple valves > mitral valve > Aortic valve

2. Caged ball > Single-tilting disk > Bileaflet-tilting disk > Bioprosthetic

53
Q

measures alterations in the intrinsic pathway of clotting cascade; used to monitor heparin therapy

A

aPTT

54
Q

measures EXTRINSIC pathway of clotting cascade and is used to monitor warfarin therapy

A

PT

55
Q

measures anti-Xa activity and may be used to monitor LMWH and fondaparinux

A

Anti-Xa

56
Q

measures activity of factors 7-11

A

ACT

57
Q

Parenteral agents: heparin

A

Unfractionted heparin (UFH)

58
Q

Parenteral agents: LMWH

A

Enoxaparin, Dalteparin, Tinzaparin

59
Q

Parenteral agents: Factor Xa inhibitors

A

Fondaparinux

60
Q

Parenteral agents: Direct thrombin inhibitors

A

Lepirudin, Bivalirudin, Desirudin, Argatroban

61
Q

Oral agents: Vit. K antagonists

A

Warfarin

62
Q

Oral agents: Factor Xa inhibitors

A

Rivaroxaban, Apixaban

63
Q

Oral agents: Direct thrombin inhibitors

A

Dabigatran

64
Q

Contraindications for anticoagulant therapy

A

Active bleeding
hemophilia
severely, uncontrolled HTN
inability to meticulously supervise and monitor (warfarin)

65
Q

Risk factors for major bleeding while on anticoagulation therapy

A

HTN, Abnormal renal/hepatic fxn, Recent surgery or history of stroke, Bleeding hx, Labile INRs on warfarin tx, Elderly, Drugs or alcohol

66
Q

tx recommendation: biosprosthetic valve in aortic position

A

Long-term ASA 81mg daily

67
Q

tx recommedation: bioprosthetic valve in mitral position

A

Warfarin 1st 3 mos (INR 2-3), then long-term ASA 81mg daily

68
Q

tx: Mechanical valve in aortic position

A

Long-term warfarin (INR 2-3)

69
Q

tx: Mechanical valve in mitral position

A

Long-term warfarin (INR 2.5-3.5)

70
Q

tx: Mechanical valve in both positions

A

Long-term warfarin (INR 2.5-3.5)

71
Q

Nonpharmacologic measures for prevention of VTE

A

Early ambulation: walk in hall 6x/day
IPC: wear compression device up to 18 hrs/day
GCS: graduated compression stockings
IVC filter: invasive, last option, requires insertion of filter to catch a clot that dislodges from a leg vein

72
Q

VTE prevention: LD UFH (low dose UFH)

A

5000 U SC BID or TID

73
Q

Prophylactic dose: Fondaparinux

A

2.5mg SC daily

74
Q

Prophylactic dose LMWH: Enoxaparin

A

30mg SC q 12 H OR

40 mg SC q 24 H

75
Q

Prophylactic dose LMWH: Dalteparin

A

2500 U or 5000 U SC q 24 H

76
Q

Prophylactic dose: Rivaroxaban

A

10 mg PO daily

77
Q

VTE prevention: ASA

A

81-325 mg PO daily

78
Q

Prophylaxis: Very low risk general surgery

A

Early ambulation

79
Q

Prophylaxis: Low risk general surgery

A

mechanical prophylaxis (IPC)

80
Q

Prophylaxis: Moderate risk general category

A

LD UFH, LMWH, or IPC

81
Q

Prophylaxis: High risk general surgery

A

LD UFH, or LMWH + GCS or IPC

82
Q

Prophylaxis: Moderate-High risk general surgery with increased bleeding risk

A

mechanical prophylaxis (IPC)

83
Q

Prophylaxis:Orthopedic surgery (knee or hip replacement)

A

LMWH (preferred), Fondaparinux, Warfarin (INR 2-3), Rivaroxaban, ASA, or IPC.

84
Q

Prophylaxis: acutely ill hospitalized medical patients at increased risk of thrombosis

A

LD UFH, LMWH, or Fondaparinux

85
Q

Acutely ill hospitalized medical patients who are bleeding or at high risk for bleeding

A

Mechanical prophylaxis (GCS or IPC)

86
Q

Duration of tx of acute coagulation

A

minimum of 5 days or until INR stable for 24H (patients transitioned to warfarin tx)

87
Q

Drugs used for chronic anticoag

A

Warfarin (INR target 2-3), continued LMWH (cancer patients), new: Rivaroxaban for both acute and chronic

88
Q

Duration of Chronic anticoag.

A

1st VTE, secondary to transient risk factor: 3 mos.
1st VTE, unprovoked: at least 3 mos.
Recurrent VTE: Long-term

cardio module (5 decks)

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