Heme Flashcards
DOAC’s increase bleed risk in these cancers
upper GI
urothelial
Highest thrombosis risk in these cancers
lung
ovarian
upper GI
brain
DOAC metabolism
cautions in which populations?
CYP 3a4
oncology patients (drug interaction)
liver impairment
renal impairment
When should anti-coagulation be stopped at EOL
no great data, but 7% bleed in last 7d noted in one study
try to stop in last days to weeks
3 key risks of embolization procedures
- puncture site complications (bleed, hematoma)
- post-embolization syndrome (pain, n/v, flu like illness)
- unintended critical ischemia
VTE anticoagulation parameters in patients with thrombocytopenia
Acute VTE
PLT > 50 - full dose
PLT < 50
- full anticoagulation with PLT transfusions (>50)
- IVC filter if transfusion not possible
Chronic VTE
PLT 25-50
- lower dose 50%
PLT <25
- hold
what are 2 antifibrinolytics?
how do they work?
how should they be administered?
TXA + aminocaproic acid
block conversion of plasminogen to plasmin
continue for 7d after bleeding stops
increase dose after 3d if bleeding continues
PLT transfusions thresholds:
- non-bleeding
- non-severe bleeding
- severe bleeding
- 10
- 30
- 50
hematuria
- what oral agents can be considered?
TXA - carefully (clot -> obstruction)
5-alpha reductase inhibitors (PCa. and BPH)
hematuria
- intra-vesical options for bleeding
- Saline irrigation
- Alum 1% - causes bladder spasm
- Aminocaproic acid - decreases fibrinolysis
- Silver nitrate - chemical cauterization
- Prostaglandin
- Formalin (need general anaesthetic)
- Tranexamic acid (home remedy in CBC)
what kind of hematuria is hyperbaric O2 helpful for?
hemorrhagic cystitis
etiology of hemorrhagic cystitis
chemo
RT
which agents have evidence for benefit in UGIB?
state the evidence for each agent
PPI - all GIB (clot less stable in acidic environments)
Octreotide - mostly variceal bleeding (PC case reports in other)
Antifibrinolytics (some evidence in GIB)
Pressins (potential role)
Treatments for RT proctitis
Sulcrate enemas
Corticosteroid enemas
Hyperbaric O2
Metronidazole
Hemoptysis is most common in which lung ca?
SCC (cavitation, necrosis)
